A 10-YEAR EXPERIENCE WITH HEPATIC RESECTION IN 338 PATIENTS - EVOLUTIONS IN INDICATIONS AND OF OPERATIVE MORTALITY

Objective. To report changes in indications for, and operative mortali ty of, elective hepatic resection during the 10 year period 1980-1989. Design: Retrospective study. Setting: District hospital. Subjects: 33 8 consecutive patients who underwent elective hepatic resection. Inter ventions: During the first five years (1980-1984) 99 resections were d one, 10 through a right thoracoabdominal incision, and the hepatic ped icle was clamped in 6. During the period 1985-1989 239 resections were done, only 7 (3%) through a thoracoabdominal incision, and the hepati c pedicle was occluded in 197 (82%). Main outcome measures: Changes in indications for operation and operative technique, and mortality. Res ults: Indications for resection in the first period were: benign lesio ns (n = 39), primary hepatic cancer (n = 30-15 had hepatocellular carc inoma associated with cirrhosis), and metastatic disease (n = 30). Six patients died, five from uncontrollable bleeding during operation. In dications during the second half were: benign lesions (n = 105, 44%), primary hepatic cancer (n = 87, 36%-62 (29%) had hepatocellular carcin oma associated with cirrhosis), and metastatic disease (n = 47, 20%). There was only 1 death during operation (air embolism), and 9 cirrhoti c patients died during the postoperative period. Conclusions: More hep atic resections are being done and the indications are changing, with more patients with cancer and benign tumours being operated on; increa sing use of pedicle occlusion has resulted in a significant decrease i n uncontrollable operative bleeding; and mortality is still related to the presence of associated cirrhosis.