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A ten-year experience with hepatic resection in 338 patients: evolutions in indications and of operative mortality
J Belghiti1, I Di Carlo, A Sauvanet
1Department of Digestive Surgery, Hôpital Beaujon, Clichy-Paris, France.
Objective:
To report changes in indications for, and operative mortality of, elective hepatic resection during the 10 year period 1980-1989.
Design:
Retrospective study.
Setting:
District hospital.
Subjects:
338 consecutive patients who underwent elective hepatic resection.
Interventions:
During the first five years (1980-1984) 99 resections were done, 10 through a right thoracoabdominal incision, and the hepatic pedicle was clamped in 6. During the period 1985-1989 239 resections were done, only 7 (3%) through a thoracoabdominal incision, and the hepatic pedicle was occluded in 197 (82%).
Main Outcome Measures:
Changes in indications for operation and operative technique, and mortality.
Results:
Indications for resection in the first period were: benign lesions (n = 39), primary hepatic cancer (n = 30-15 had hepatocellular carcinoma associated with cirrhosis), and metastatic disease (n = 30). Six patients died, five from uncontrollable bleeding during operation. Indications during the second half were: benign lesions (n = 105, 44%), primary hepatic cancer (n = 87, 36%-62 (29%) had hepatocellular carcinoma associated with cirrhosis), and metastatic disease (n = 47, 20%). There was only 1 death during operation (air embolism), and 9 cirrhotic patients died during the postoperative period.
Conclusions:
More hepatic resections are being done and the indications are changing, with more patients with cancer and benign tumours being operated on; increasing use of pedicle occlusion has resulted in a significant decrease in uncontrollable operative bleeding; and mortality is still related to the presence of associated cirrhosis.