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Related Experiment Videos

Peri-operative mortality in hepatic resection.

J J Tjandra1, S T Fan, J Wong

  • 1Department of Surgery, University of Hong Kong, Queen Mary Hospital.

The Australian and New Zealand Journal of Surgery
|March 1, 1991
PubMed
Summary

Hepatic resections for hepatocellular carcinoma (HCC) carry significant risks, especially right lobectomies in patients with cirrhosis or poor liver function. Massive blood loss during surgery dramatically increases operative mortality and hepatic failure in HCC patients.

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Area of Science:

  • Hepatobiliary Surgery
  • Surgical Oncology
  • Gastroenterology

Background:

  • Hepatic resections are crucial for treating liver diseases, including hepatocellular carcinoma (HCC).
  • Assessing operative outcomes and risk factors is essential for improving patient survival after major liver surgery.

Purpose of the Study:

  • To report the operative results of hepatic resections over a 28-month period.
  • To identify risk factors associated with operative mortality and postoperative complications in patients undergoing hepatic resection, particularly those with HCC.

Main Methods:

  • Retrospective analysis of 67 hepatic resections performed over 28 months.
  • Categorization of patients based on diagnosis (HCC vs. non-HCC) and surgical procedure (e.g., lobectomy, extended lobectomy).

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  • Evaluation of operative mortality, postoperative hepatic failure, and correlation with patient factors (cirrhosis, liver function) and surgical events (blood loss, hemorrhage).

    • Main Results:

    • Overall operative mortality was 10%, with 15% for HCC and 0% for non-HCC diseases.
    • In HCC patients, right or extended right lobectomy had higher mortality, especially with cirrhosis (32%) or Child's C liver function (60%).
    • Massive peri-operative blood loss (≥4.0 L) significantly increased operative mortality (47%) and hepatic failure (73%) in HCC patients.

    Conclusions:

    • Right or extended right lobectomy in HCC patients is associated with high mortality, particularly in those with underlying cirrhosis or impaired liver function.
    • Massive peri-operative blood loss is a critical factor driving operative mortality and postoperative hepatic failure after hepatic resection for HCC.
    • Postoperative hepatic failure, while common in fatalities, is secondary to massive blood loss rather than an independent prognostic factor.