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One-Year Mortality after Hepatectomy: Defining a Novel Quality Metric.

Lily V Saadat1, Debra A Goldman2, Hannah Kalvin2

  • 1Division of Hepatopancreatobiliary, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. saadatl@mskcc.org.

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One in ten patients die within a year of hepatectomy, a significant rate not captured by shorter-term mortality metrics. Malignancy and major complications are key factors influencing this 1-year mortality after liver surgery.

Keywords:
ComplicationsHepatectomyMortalityOutcomesResection

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Area of Science:

  • Hepatobiliary Surgery
  • Surgical Oncology
  • Gastroenterology

Background:

  • 30- and 90-day mortality after hepatectomy have improved due to advancements in surgical techniques and perioperative care.
  • However, long-term survival, specifically within the first year post-hepatectomy, remains less understood.

Purpose of the Study:

  • To investigate the 1-year survival rates following hepatectomy.
  • To identify clinical factors associated with mortality within the first year after liver surgery, including for patients with colorectal liver metastases (CRLM).

Main Methods:

  • Retrospective analysis of 6191 adult patients who underwent hepatectomy between 1991-2018.
  • Univariable and multivariable logistic regression analyses were employed to determine predictors of 1-year mortality.
  • Specific analysis was conducted on a subset of patients who underwent hepatectomy for CRLM.

Main Results:

  • Overall 1-year survival was 89.9%. For patients surviving 90 days, 1-year survival probability was 92.2%.
  • Malignancy (OR: 5.82), major complications (OR: 2.84), and open surgical approach (OR: 2.06) were significantly associated with 1-year mortality in the overall cohort.
  • In the CRLM subgroup, major complications (OR: 2.94), 1-year recurrence (OR: 2.78), multiple liver lesions (OR: 2.12), and hepatitis B/C (OR: 3.47) were associated with 1-year mortality.

Conclusions:

  • 1-year mortality after hepatectomy is substantial, affecting approximately 10% of patients.
  • Unlike short-term mortality, 1-year mortality offers a broader perspective on postoperative outcomes, encompassing postsurgical events and disease progression.