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Published on: August 16, 2019
Liver resections between 2014 and 2020 in the Lausanne University Hospital, Switzerland
Kosuke Kobayashi1, Emilie Uldry1, Nicolas Demartines1
1Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Insights
This study analyzed 400 liver resections, finding a 45.5% morbidity rate. As patient populations age, improving preoperative management and surgical techniques for liver resection is crucial.
Area of Science:
- Hepatobiliary Surgery
- Surgical Outcomes Analysis
- Oncology
Background:
- Lausanne University Hospital serves a population of 1 million.
- Liver resection is a critical procedure for various liver pathologies.
Purpose of the Study:
- To analyze baseline characteristics and surgical outcomes of liver resections.
- To evaluate trends in patient demographics and surgical approaches over time.
Main Methods:
- Retrospective analysis of 400 consecutive liver resections.
- Data collection from January 2014 to February 2020.
- Pathological results and complication rates (Clavien-Dindo classification) were recorded.
Main Results:
- The most common pathology was liver metastases (51.8%), followed by primary liver cancer (21.8%).
- Overall morbidity was 45.5%, with major complications (Clavien-Dindo ≥ 3) in 20.3% of patients.
- The later period (2017-2019) showed a significant increase in elderly patients (≥ 75 years) and laparoscopic procedures.
Conclusions:
- Liver resection outcomes are influenced by patient age and surgical technique.
- Continuous improvement in preoperative management and surgical strategies is necessary to address an aging patient population.
Abstract:
Lausanne University Hospital is in the Francophone part of Switzerland and services a catchment population of about 1 million people. We recorded and analyzed baseline characteristics and surgical outcomes for 400 consecutive patients who underwent liver resection there between January 2014 and February 2020. Their pathological results were primary liver cancer (including hepatocellular carcinoma and intrahepatic cholangiocarcinoma): 21.8%, extrahepatic cholangiocarcinoma (including perihilar cholangiocarcinoma and gallbladder cancer): 5.3%, liver metastases: 51.8%, echinococcosis: 10.8%, adenoma: 3.0%, and other diagnoses: 7.5%. Global morbidity rate (Clavien-Dindo classification ≥ 1) was 45.5% with major complication (Clavien-Dindo classification ≥ 3) identified in 81 patients (20.3%). Of the 400 patients, two died within 30 days of surgery (0.5%) and five died within 90 days (1.3%). The 2017-2019 subgroup had a significantly greater percentage of patients aged ≥ 75 years (20.5%) than did the 2014-2016 subgroup (10.9%; p = 0.011) and a higher percentage of laparoscopic procedures than the earlier subgroup (2014-2016: 9.2%, 2017-2019: 32.5%; p < 0.001). We conclude that as the patient population ages, preoperative management and surgical techniques should be constantly improved.
