Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1994 Aug;220(2):199–205. doi: 10.1097/00000658-199408000-00012

Trends in morbidity and mortality of hepatic resection for malignancy. A matched comparative analysis.

J I Tsao 1, J P Loftus 1, D M Nagorney 1, M A Adson 1, D M Ilstrup 1
PMCID: PMC1234360  PMID: 8053742

Abstract

OBJECTIVE: The authors define more clearly the trends in morbidity and mortality after hepatic resection for malignant disease in matched patient groups during two discrete time periods. SUMMARY BACKGROUND DATA: Recent reports have shown improvement in operative morbidity and mortality associated with hepatic resection; however, results often included resections for benign disease and trauma. Furthermore, specific factors contributing to the improvement in operative risks between the last two decades have not been defined. METHODS: A retrospective matched comparative analysis was conducted of patients with primary and metastatic hepatic malignancy resected with curative intent between two periods (1976 to 1980 and 1986 to 1990). Eighty-one patients met our inclusion criteria in the early period; this group was matched with 81 patients from the latter period by the following four parameters: age, gender, type of malignant disease, and extent of resection. Records of these two patient groups were abstracted for clinical presentation, co-morbid factors, operative techniques, and perioperative morbidity and mortality. RESULTS: The authors found a significant decrease in operative morbidity, median perioperative transfusion, and length of hospital stay in the latter period (1986 to 1990). The incidence of postoperative subphrenic abscess and intra-abdominal hemorrhage was significantly lower during this period. Operative mortality rate was similar for both periods, 4.9% and 1.2%, respectively (p > 0.05). CONCLUSION: Hepatic resection for malignant disease currently can be performed with a low morbidity and mortality in the hands of trained and experienced hepatic surgeons; operative risks of hepatic resection should not deter its application in the treatment of primary and metastatic malignant disease of the liver.

Full text

PDF
199

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adson M. A. Resection of liver metastases--when is it worthwhile? World J Surg. 1987 Aug;11(4):511–520. doi: 10.1007/BF01655817. [DOI] [PubMed] [Google Scholar]
  2. Augelli N. V., Lucas R. J., Howells G. A. Hepatic resections: an eight year experience at a community hospital. Am Surg. 1988 Jun;54(6):373–375. [PubMed] [Google Scholar]
  3. Bengmark S., Hafström L., Jeppsson B., Sundqvist K. Primary carcinoma of the liver: improvement in sight? World J Surg. 1982 Jan;6(1):54–60. doi: 10.1007/BF01656373. [DOI] [PubMed] [Google Scholar]
  4. Brown D. A., Pommier R. F., Woltering E. A., Fletcher W. S. Nonanatomic hepatic resection for secondary hepatic tumors with special reference to hemostatic technique. Arch Surg. 1988 Sep;123(9):1063–1066. doi: 10.1001/archsurg.1988.01400330039005. [DOI] [PubMed] [Google Scholar]
  5. Cady B., Bonneval M., Fender H. R., Jr Elective hepatic resection. Am J Surg. 1979 Apr;137(4):514–521. doi: 10.1016/0002-9610(79)90123-5. [DOI] [PubMed] [Google Scholar]
  6. Cole D. J., Ferguson C. M. Complications of hepatic resection for colorectal carcinoma metastasis. Am Surg. 1992 Feb;58(2):88–91. [PubMed] [Google Scholar]
  7. Delva E., Camus Y., Nordlinger B., Hannoun L., Parc R., Deriaz H., Lienhart A., Huguet C. Vascular occlusions for liver resections. Operative management and tolerance to hepatic ischemia: 142 cases. Ann Surg. 1989 Feb;209(2):211–218. doi: 10.1097/00000658-198902000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Feliciano D. V., Mattox K. L., Jordan G. L., Jr, Burch J. M., Bitondo C. G., Cruse P. A. Management of 1000 consecutive cases of hepatic trauma (1979-1984). Ann Surg. 1986 Oct;204(4):438–445. doi: 10.1097/00000658-198610000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Fortner J. G., MacLean B. J., Kim D. K., Howland W. S., Turnbull A. D., Goldiner P., Carlon G., Beattie E. J., Jr The seventies evolution in liver surgery for cancer. Cancer. 1981 May 1;47(9):2162–2166. doi: 10.1002/1097-0142(19810501)47:9<2162::aid-cncr2820470909>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  10. Foster J. H. Survival after liver resection for cancer. Cancer. 1970 Sep;26(3):493–502. doi: 10.1002/1097-0142(197009)26:3<493::aid-cncr2820260302>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  11. Hodgson W. J., Morgan J., Byrne D., DelGuercio L. R. Hepatic resections for primary and metastatic tumors using the ultrasonic surgical dissector. Am J Surg. 1992 Feb;163(2):246–250. doi: 10.1016/0002-9610(92)90110-d. [DOI] [PubMed] [Google Scholar]
  12. Holm A., Bradley E., Aldrete J. S. Hepatic resection of metastasis from colorectal carcinoma. Morbidity, mortality, and pattern of recurrence. Ann Surg. 1989 Apr;209(4):428–434. doi: 10.1097/00000658-198904000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Iwatsuki S., Starzl T. E. Personal experience with 411 hepatic resections. Ann Surg. 1988 Oct;208(4):421–434. doi: 10.1097/00000658-198810000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Jamieson G. G., Corbel L., Campion J. P., Launois B. Major liver resection without a blood transfusion: is it a realistic objective? Surgery. 1992 Jul;112(1):32–36. [PubMed] [Google Scholar]
  15. Leese T., Bismuth H. Surgical management of space-occupying lesions in the liver. Baillieres Clin Gastroenterol. 1989 Jan;3(1):253–277. doi: 10.1016/0950-3528(89)90055-9. [DOI] [PubMed] [Google Scholar]
  16. Nagorney D. M., van Heerden J. A., Ilstrup D. M., Adson M. A. Primary hepatic malignancy: surgical management and determinants of survival. Surgery. 1989 Oct;106(4):740–749. [PubMed] [Google Scholar]
  17. Nordlinger B., Quilichini M. A., Parc R., Hannoun L., Delva E., Huguet C. Hepatic resection for colorectal liver metastases. Influence on survival of preoperative factors and surgery for recurrences in 80 patients. Ann Surg. 1987 Mar;205(3):256–263. doi: 10.1097/00000658-198703000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Olak J., Wexler M. J., Rodriguez J., McLean A. P. Hepatic resection for metastatic disease. Can J Surg. 1986 Nov;29(6):435–439. [PubMed] [Google Scholar]
  19. Pace R. F., Blenkharn J. I., Edwards W. J., Orloff M., Blumgart L. H., Benjamin I. S. Intra-abdominal sepsis after hepatic resection. Ann Surg. 1989 Mar;209(3):302–306. doi: 10.1097/00000658-198903000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Pachter H. L., Spencer F. C., Hofstetter S. R., Liang H. G., Coppa G. F. Significant trends in the treatment of hepatic trauma. Experience with 411 injuries. Ann Surg. 1992 May;215(5):492–502. doi: 10.1097/00000658-199205000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Savage A. P., Malt R. A. Elective and emergency hepatic resection. Determinants of operative mortality and morbidity. Ann Surg. 1991 Dec;214(6):689–695. doi: 10.1097/00000658-199112000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Scheele J., Stangl R., Altendorf-Hofmann A. Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br J Surg. 1990 Nov;77(11):1241–1246. doi: 10.1002/bjs.1800771115. [DOI] [PubMed] [Google Scholar]
  23. Silen W. Hepatic resection for metastases from colorectal carcinoma is of dubious value. Arch Surg. 1989 Sep;124(9):1021–1022. doi: 10.1001/archsurg.1989.01410090027004. [DOI] [PubMed] [Google Scholar]
  24. Stimpson R. E., Pellegrini C. A., Way L. W. Factors affecting the morbidity of elective liver resection. Am J Surg. 1987 Feb;153(2):189–196. doi: 10.1016/0002-9610(87)90812-9. [DOI] [PubMed] [Google Scholar]
  25. Thompson H. H., Tompkins R. K., Longmire W. P., Jr Major hepatic resection. A 25-year experience. Ann Surg. 1983 Apr;197(4):375–388. doi: 10.1097/00000658-198304000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Vetto J. T., Hughes K. S., Rosenstein R., Sugarbaker P. H. Morbidity and mortality of hepatic resection for metastatic colorectal carcinoma. Dis Colon Rectum. 1990 May;33(5):408–413. doi: 10.1007/BF02156268. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES