Improving operative safety for cirrhotic liver resection

Background: Liver resection in a patient with cirrhosis carries increased r isk. The purposes of this study were to review the results of cirrhotic liv er resection in the past decade and to propose safe strategies for cirrhoti c liver resection. Methods: Based on the date of operation, 359 cirrhotic liver resections in 329 patients were divided into two intervals: period 1, from September 1989 to December 1994, and period 2, from January 1995 to December 1999. The pa tient backgrounds, operative procedures and early postoperative results wer e compared between the two periods. The factors that influenced surgical mo rbidity were analysed. Results: In period 2, patient age was higher and the amounts of blood loss and blood transfused were lower. Although postoperative morbidity rates wer e similar, blood transfusion requirement, postoperative hospital stay and m ortality rate were significantly reduced in period 2. No death occurred in 154 consecutive cirrhotic liver resections in the last 38 months of the stu dy. Prothrombin activity and operative time were independent factors that i nfluenced postoperative morbidity. Conclusion: With improving perioperative assessment and operative technique s, most complications after cirrhotic liver resection can be treated with a low mortality rate. However, more care should be taken if prothrombin acti vity is low or there is a long operating time.