The impact of new technology on hepatic resection for malignancy

Hypothesis: Relatively high morbidity rates remain problematic in hepatic r esection for malignant neoplasms. Technological innovations coupled with su rgical expertise can ameliorate morbidity and mortality rates. Design: Medical records survey. Setting: Tertiary care university hospital. Patients: Five hundred one patients underwent liver resection at our hospit al from March 1, 1988, through November 30, 1999. Three hundred twenty-one patients (64.1%) had primary carcinoma, whereas 180 (35.9%) had metastatic disease, mainly colorectal secondary disease (83.3%). Morbidity and mortali ty rates were compared with those of a previous series in the same setting. Main Outcome Measures: Special attention was paid to the impact of new tech nology (eg, newer imaging techniques, Ultrasonic aspiration, intraoperative ultrasonography, argon beam coagulation, and autotransfusion) and improved anesthetic and surgical management on mortality and morbidity rates. Results: Five patients died after liver resection and 93 patients had vario us complications, representing mortality and morbidity rates of 1.0% and 18 .6%, respectively. These results compare favorably with the results of a pr evious unpublished series (mortality, 5/55 [9.1%]; morbidity, 28/55 [50.9%] ). Intraoperative ultrasonography resulted in a change in operative strateg y in 7 (17.5%) of a recent group of 40 patients. Conclusions: Morbidity after major hepatic resection for malignancy can be reduced considerably by applying newer technologies to preoperative and int raoperative decision making. Advanced technology also assists in reducing i ntraoperative risk by minimizing bleeding during resection of the hepatic p arenchyma.