Two hundred and forty-one consecutive liver resections: an experience from India

Although liver resection has become an established procedure in western countries and South-east Asia it is still not performed frequently in most centres in India. In the last 10 years newly created specialized units have been performing more liver resections but no major series have been reported.

We analysed the results of 241 hepatic resections in the Gyan Burman Liver Unit, Sir Ganga Ram Hospital to compare our results with those published from established centres and to identify the factors relating to morbidity and mortality. To examine the effect of a greater experience with the procedure we compared the outcome of our operations from 1996-2000 (first period) and those from 2001-2005 (second period).

The overall mortality and morbidity rates were 6.6% and 44.8%, respectively, which are comparable with those of most recently published Western series. Life-threatening complications occurred in 12.4% patients. Multivariate analysis showed that the presence of comorbid conditions, intraoperative blood transfusions of >3 units, hepatocellular carcinoma with underlying cirrhosis and gall bladder carcinoma with jaundice were the independent risk factors for morbidity, whereas the presence of comorbid illness and underlying liver cirrhosis were the risk factors for mortality. During the second period there was an increase in the number of operations performed (66 vs 175; first vs second period), but the mortality rates remained essentially unchanged (6.1% vs 6.8%).

Hepatic resections can be performed safely in India with results comparable to those achieved in the West. Increasing experience did not reduce overall mortality. Perhaps more careful patient selection and better perioperative management of comorbid illnesses may reduce the morbidity and mortality further.