IS RADICAL HEPATIC SURGERY SAFE

BACKGROUND: A prospective review of 200 consecutive liver resections p erformed for benign and malignant disease, between 1989 and 1995 at th e Hammersmith Hospital, was undertaken to evaluate the safety of radic al hepatic resection. METHODS: The indications for operation were: hep atocellular carcinoma (n = 39), cholangiocarcinoma (n = 21), gall blad der carcinoma (n = 8), colorectal secondaries (n = 75), noncolorectal secondaries (n = 35), and benign disease (n = 26). Twenty patients wer e cirrhotic and 36 were jaundiced. Major resections were performed in 74% of cases and included 63 extended hepatectomies, 17 repeated resec tions for recurrent colorectal metastases, and 17 resections combined with vascular reconstruction. Total vascular exclusion of the liver wa s used in the majority of cases. RESULTS: The overall mortality rate w as 5%. Thirty-day mortality was 2.5%. Sepsis and not hemorrhage was th e most common cause of death. There were 101 complications that occurr ed in 37% of the patients. The main complications were subphrenic absc ess and biliary leak. The extent of liver resection (major versus mino r) significantly increased the risk of morbidity (46% versus 16%). Blo od loss greater than 100 mt increased the risk of morbidity from 12% t o 25%. CONCLUSIONS: Major hepatic resection can be achieved with accep table mortality but high morbidity rates. (C) 1998 by Excerpta Medica, Inc.