Factors affecting the morbidity of elective liver resection

To identify the determinants of morbidity and mortality after hepatic lobectomy, we studied 17 potential risk factors in 58 consecutive patients who had right hepatic lobectomy (39 patients), left hepatic lobectomy (10 patients), extended right hepatic lobectomy (6 patients), and left lateral segmentectomy (3 patients). The lesions were benign neoplasm (11 patients), primary malignancy (12 patients), metastatic neoplasm (28 patients), and inflammatory conditions, namely, stones, ductal strictures, and abscess (7 patients). Two patients died (3.8 percent), one from operative hemorrhage and the other from sepsis. Major complications occurred in 29 patients (50 percent). The presence of diabetes or pulmonary disease correlated with the development of complications. Infection occurred in four of five patients with diabetes. The incision was extended into the thorax in nine patients, all of whom had complications. The mean weight of the resected specimen did not differ between patients who underwent thoracotomy and those who did not, but the two largest specimens (over 2 kg) were removed without thoracotomy. Minor complications developed in two patients with benign tumors. Biliary fistulas developed in three of seven patients with inflammatory conditions. Infectious complications were decreased in the presence of adequate perioperative antibiotics and closed drainage of the subphrenic space. These data show that in fit patients, elective liver resection can be performed with a low morbidity and mortality; diabetes, pulmonary disease, and inflammatory lesions increase the risk of hepatic resections; adequate antibiotics and closed drainage decrease the risk of infection; and thoracotomy markedly increases the chance of complications. Finally, since elective resection can nearly always be performed without thoracotomy, it should be avoided in most patients.