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Updated: Jan 3, 2026
Laparoscopic Anatomical Liver Segment VII Resection with Liver Parenchymal Transection Following a Priority Approach
Published on: May 23, 2025
Prediction of perioperative outcome after hepatic resection for pediatric patients
Jianxia Liu1, Yunfei Zhang2, Hai Zhu2
1Department of Anesthesiology, Children's Hospital, Chongqing Medical University, Chongqing, People's Republic of China.
Insights
Pediatric liver resections carry risks, but operative outcomes can be improved. Key factors influencing complications include estimated blood loss and the extent of hepatectomy, with techniques like the Pringle maneuver showing promise.
Area of Science:
- Pediatric surgery
- Hepatobiliary surgery
- Surgical oncology
Background:
- Hepatic resection in children presents significant risks of morbidity and mortality.
- Optimizing surgical techniques and perioperative management is crucial for improving outcomes.
- Perioperative variables impacting postoperative outcomes in pediatric hepatectomy require definition.
Purpose of the Study:
- To identify perioperative variables associated with improved postoperative outcomes in pediatric hepatectomy.
- To analyze factors influencing complications in pediatric liver resections.
Main Methods:
- Retrospective review of 156 pediatric patients undergoing hepatectomy (2006-2016).
- Analysis of demographic, intraoperative variables, complications, and hospital stay.
- Univariate and multivariate analyses to determine predictors of postoperative outcomes.
Main Results:
- Overall mortality was 1.9%, with a 44.2% complication rate.
- Estimated blood loss (EBL), extent of hepatectomy, and Pringle maneuver were independent predictors of complications.
- Malignant and benign liver diseases comprised 47.4% and 52.6% of resections, respectively.
Conclusions:
- The extent of hepatectomy and estimated blood loss are major contributors to perioperative complications.
- Surgical innovations and management strategies, such as the Pringle maneuver, can optimize treatment planning.
- Further research into optimizing pediatric liver resection techniques is warranted.
Background:
Hepatic resection is associated with significant risk of morbidity and mortality. Optimising the surgical techniques and perioperative management may improve in operative morbidity and mortality. However, perioperative variables involved in the improvement for postoperative outcomes in pediatric hepatectomy have not been defined.
Methods:
We retrospectively reviewed 156 consecutive pediatric patients who underwent hepatectomy at our center (an academic tertiary care hospital) between 2006 and 2016. Baseline demographic variables, intraoperative variables, complications, and hospital stay were explored. The patients were further investigated using univariate and multivariate analysis for the factors involved in the postoperative outcomes.
Results:
Of the conditions requiring resections, malignant and benign liver diseases accounted for 47.4% (74/156) and 52.6% (82/156), respectively. The overall hospital mortality was 1.9% (3/156) and the overall postoperative complication rate was 44.2% (69/156). Anatomical resections were performed in 128 patients (82.1%), including 14(9.0%) extended hepatectomies. Eighty percent of patients had three or more segments resected. The median operative time was 167.7 (65-600) minutes and median estimated blood loss was 320.1(10-1600) mL. On multivariate analysis, the estimated blood loss (EBL) (mL) (OR, 2.19; 95CI, 1.18-3.13; p = 0.016), extent of hepatectomy (OR, 1.81; 95CI, 1.06-2.69; p = 0.001) and pringle maneuver (OR, 1.38; 95CI, 1.02-1.88; p = 0.038) were the independent predictors of postoperative complications.
Conclusions:
Extent of hepatectomy and estimated blood loss are largely responsible for the perioperative complications. With the surgical devices and management amelioration, like pringle maneuver, the treatment planning may be optimize in pediatric liver resection.
