The Safety of Elective Liver Resection in a Special Unit

Abstract

The benefit of hepatic surgery for benign or malignant conditions is a balance between peri-operative morbidity/mortality and long-term potential for cure or palliation. The aim of this retrospective study was to illustrate that the safety of liver resection is a function of the frequenty of performance of the procedure. Between 1973 and 1992, 327 elective liver resections were performed. The indication for surgery was malignant tumour in 275 cases of which 170 (62%) and 105 (38%) were for metastatic and primary disease, respectively, and non-malignant conditions in 52 cases. The series included the complete spectrum of hepatectomies. There were nine deaths (2.7%). Mortality was 8% (3/38) before 1985,3.4% (3/89) between 1985-88 and 1.5% (3/200) between 1989-92. In non-jaundicedhon-cirrhotic patients, mortality was 1.4% (4/270). Morbidity, defined as the incidence of at least one major complication, occurred in 87 patients (26.6%) with a re-operation rate of 6.4%. During the same time periods, the morbidity rate was 42, 35 and 20%, respectively, and the median blood transfusion requirement and postoperative stay progressively decreased to 2 units and 9 days, respectively. In conclusion, as experience was gained, the need for blood transfusion diminished, morbidity and mortality improved and the hospital stay shortened.

Laparoscopic liver resection of benign liver tumors

“…All transfused patients (6%) received autologous blood transfusion, but it should be noted that the same resection procedures performed by an open approach would probably not have required blood transfusion. The need for blood transfusion in minor liver resections on a noncirrhotic liver parenchyma is indeed minimal when using an open approach [63][64][65]. This feature confirmed that bleeding remains the most important intraoperative problem during liver resection, as in open surgery, but is obviously more difficult to control laparoscopically, even for minor resections.…”

“…However, in this selected group of patients, when the technique is appropriately performed by an expert surgical team, the technique appears to be safe, with a low morbidity and a short postoperative hospital stay. However, it should be remembered that open resectional liver surgery has achieved a significant reduction in postoperative morbidity, especially for minor liver resections [64,65]. Additional comparative studies are needed to evaluate the benefit of the laparoscopic approach in terms of postoperative recovery.…”

Concurrent vs. Staged Colectomy and Hepatectomy for Primary Colorectal Cancer With Synchronous Hepatic Metastases

“…9 Data regarding safety of hepatic resection by experienced hepatobiliary surgeons similarly support this approach. 10,11 Evaluation of patients for resectability of colorectal cancer demands thorough cancer staging. Rapidsequence CT imaging of the chest and whole abdomen is the preferred technique.…”

Early Experience With Laparoscopic Approach for Solid Liver Tumors: Initial 16 Cases

“…However, laparoscopic liver surgery has been slow to develop because of perceived technical difficulties. The gradual trend toward bloodless surgery in traditional techniques of hepatic resection, 17,18 greater experience with laparoscopic surgery, and improvements in video equipment, laparoscopic instrumentation, and surgical skills have led hepatobiliary surgeons to attempt laparoscopic management of various hepatic lesions. 6,9,19 Management of biliary cysts offers good training for laparoscopic liver surgery.…”