[Hepatic resections. The results of using CUSA]

Hepatic tumours, both primaries and secondaries, are common. They are seldom operable, but curative resections are sometimes possible. The aims of the study were to present the result and experience of liver operations (primaries, secondaries and benign lesions) and to present the result of using CUSA in these operations. A retrospective study was carried out to evaluate the result of elective hepatic resections in Iceland between 1986-1993 with the aid of CUSA. The type of tumour and resection, operative bleeding, transfusions, hospital stay and complications were noted. Kaplan-Meyer lifetable was used to estimate survival. Fourteen patients underwent fifteen operations, followed by six complications which resulted in five reoperations and one percutaneous drainage. Bleeding was 3000 ml (median, range 350-10.600 ml), transfusion was 3000 ml (median, range 0-12.000 ml) and hospital stay was 24 days (range 9-108 days). There was no operative mortality. Four of nine patients operated for secondaries are living (44%), 15, 41, 46 og 72 months postoperatively (two with recurrence). Two patients were operated for hepatomas, and one of those is alive 86 months postoperatively and is considered to be cured. We conclude that hepatic resection can be carried out in small centers with comparable results to large published series. The ultrasonic scalpel CUSA seems to make the resection tecnically easier and to diminish the amount of bleeding.