Complications of Elective Liver Resections in a Center With Low Mortality

Abstract

To develop a score predicting the morbidity of liver resections in a center with low mortality. Design, Setting, and Patients: The study was based on a prospective database of all liver resections performed at the Geneva University Hospitals between January 1, 1991, and October 30, 2009 (a total of 726 elective liver resections in 689 patients). Perioperative complications and their severity were graded according to the original classification by Clavien et al. Variables independently associated with the occurrence of complications were identified using a linear regression analysis model. A score was computed with all independent variables in an assessment population including two-thirds of the liver resections and was further validated in a population including one-third of the liver resections. Results: Overall mortality was 0.7% (5 of 726 liver resections). We recorded 375 different complications in 259 hepatic resections (36% of resections had Ն1 complication). In the assessment group, resection of 3 or more segments, an American Society of Anesthesiologists score of 3 or higher, and resection for a malignant neoplasm independently predicted the risk of complications. A score integrating these 3 factors significantly predicted the risk of postoperative complications. The score also correlated with the occurrence of major complications. Conclusion: The score allows for identification of patients most susceptible to complications, in whom efforts against specific postoperative morbidities can be concentrated.

Development and Validation of a Prediction Score for Complications after Hepatectomy in Hepatitis B-Related Hepatocellular Carcinoma Patients

“…Although, all the liver resections were performed when the CTP class was A, 52% of death was caused by liver failure (12/23), probably owing to the damaged hepatic parenchyma of HBV and better function of other organs. With an overall 30.1% morbidity rate, our results were consistent with those reported in recent studies [1], [3], [6], [7], [8], [9], [10]. Death was rare in our cohort, therefore it was not analyzed alone and combined with other lethal complication(complication III–IV).…”

“…Therefore, the focus of liver surgery has turned on strategies to prevent nonlethal complications and develop tools to identify preoperatively potential patients at higher risk for severe complications [1]. Many factors may contribute to postoperative complications and have been verified by other studies [1], [2], [6]–[14], including liver function, portal hypertension, extent of liver resection,blood loss and anesthesiologists category and so on. To prevent complications,it is essential to identify, ideally preoperatively, those patients at risk to develop poor outcome and perform prevention strategies [14].…”

Abandoning Prophylactic Abdominal Drainage after Hepatic Surgery: 10 Years of No-Drain Policy in an Enhanced Recovery after Surgery Environment

“…Major liver resection is a known risk factor for postoperative complications [12,13,[28][29][30][31][32][33][34][35] . In this study, it was identified in multivariate analysis as an independent risk factor for RSR-significant morbidity and RSR reinterventions.…”

Current status of robotic liver resection: a systematic review

“…With minimally invasive surgery, surgical stress is reduced, whether it is by a robotic or a laparoscopic approach. Besides, as for laparoscopy [25,32], the robotic results compare more than favorably with open surgery [33], notably by minimizing blood loss and the risk of transfusion (in the selected published patients).…”