Peri-operative mortality in hepatic resection

The operative results of hepatic resections (n = 67) during the past 28 months are reported. Major hepatic resection (lobectomy, extended lobectomy) was performed in 78% of patients with hepatocellular carcinoma (HCC) and in 24% of patients with non-HCC diseases. The overall operative mortality was 10%: 15% for HCC and 0% for non-HCC diseases. The operative mortality in the HCC group occurred exclusively in patients who had undergone right or extended right lobectomy. The operative mortality of right or extended right lobectomy in patients with HCC increased considerably with the presence of cirrhosis (32% vs 0%) and a liver function worse than Child's A (60% vs 17%). In HCC, the incidence of operative mortality (47%) and postoperative hepatic failure (73%) was higher when there had been massive operative blood loss (greater than or equal to 4.0 L) and/or persistent postoperative haemorrhage, compared with 0% and 24% respectively in cases without massive peri-operative bleeding. While postoperative hepatic failure was present in 5 of 7 fatalities, it was not an independent prognostic factor, but was dependent on the presence of massive peri-operative blood loss.