OPERATIVE RISKS OF MAJOR HEPATIC RESECTIONS

Background/Aims: Despite recent advances in liver surgery, major hepat ic resection still remains a major operation with significant mortalit y and morbidity. We report our experience with major hepatic resection s with particular regard to the operative risk of this procedure in ci rrhotic and non-cirrhotic patients. Methodology: One hundred and ninet y-three patients with malignant (77.2%) or benign (22.8%) liver tumors underwent major hepatic resection between January 1981 and December 1 995. Twenty-eight patients had cirrhosis. We performed 109 right hepat ectomies (56.5%), 30 right extended hepatectomies (15.5%), 32 left hep atectomies (16.6%), 15 left extended hepatectomies (7.8%) and 7 triseg mentectomies (3.6%). In 63 patients (32.6%), single or multiple associ ated resections were performed. Selected intraoperative and outcome da ta were compared in this retrospective analysis. Results: There were 9 intraoperative complications: 4 injuries of the contralateral biliary duct, 4 injuries of the vena cava and 1 partial stricture of the left hepatic vein. The mean operation time was 284+/-97.9 min. The mean nu mber of transfused units of blood was 1.6+/-1.8. The patients with ope rative complications required a median. of 5 units of blood (range:l-l l) (p = 0.001). The intra-and postoperative mortality was 3.1%. Sevent y-six patients (39.3%) developed postoperative complications, and 20.7 % of these were major complications. Blood replacement was significant ly higher in the cirrhotic patients (p=0.007). No other significant di fferences were found between the cirrhotic and non-cirrhotic patients. Conclusions: Major hepatic resection for malignant or benign disease cart be performed safely with minimal morbidity and mortality in patie nts with normal livers and in selected cirrhotic patients classified a s Pugh A.