THE SAFETY OF ELECTIVE LIVER RESECTION IN A SPECIAL UNIT

The benefit of hepatic surgery for benign or malignant conditions is a balance between peri-operative morbidity/mortality and long-term pote ntial for cure or palliation. The aim of this retrospective study was to illustrate that the safety of liver resection is a function of the frequenty of performance of the procedure. Between 1973 and 1992, 327 elective liver resections were performed. The indication for surgery w as malignant tumour in 275 cases of which 170 (62%) and 105 (38%) were for metastatic and primary disease, respectively, and non-malignant c onditions in 52 cases. The series included the complete spectrum of he patectomies. There were nine deaths (2.7%). Mortality was 8% (3/38) be fore 1985, 3.4% (3/89) between 1985-88 and 1.5% (3/200) between 1989-9 2. In non-jaundiced/non-cirrhotic patients, mortality was 1.4% (4/270) . Morbidity, defined as die incidence of at least one major complicati on, occurred in 87 patients (26.6%) with a re-operation rate of 6.4%. During the same time periods, the morbidity rate was 42, 35 and 20%, r espectively, and the median blood transfusion requirement and postoper ative stay progressively decreased to 2 units and 9 days, respectively . In conclusion, as experience was gained, the need for blood transfus ion diminished, morbidity and mortality improved and the hospital stay shortened.