One thousand fifty-six hepatectomies without mortality in 8 years.
By H. Imamura, Y. Seyama, N. Kokudo, A. Maema, Y. Sugawara, K. Sano, T. Takayama, M. Makuuchi. Archives of Surgery, 2003
844 citations recorded by the source corpus.
BACKGROUND Despite improvements in diagnostic and surgical techniques, operative mortality associated with liver resection is still greater than 2% in most of the recent studies. HYPOTHESIS By refining preoperative and postoperative care and surgical skills, liver resection mortality can be decreased to zero. DESIGN Retrospective cohort study to analyze postoperative morbidity and mortality in 1056 consecutive hepatectomies performed at a single medical center during 8 years. SETTING Tertiary referral center. PATIENTS A total of 915 patients who underwent 1056 consecutive hepatic resections: 532 for hepatocellular carcinoma, 262 for other primary and secondary liver malignancies, 57 for biliary tract malignancy, 174 for living donor liver transplantation, and 31 for other benign diseases. MAIN OUTCOME MEASURES Operative mortality and morbidity rates. RESULTS No operative mortality occurred. Major complications, as defined by postoperative radiologic or surgical intervention, occurred in 3% of patients with hepatocellular carcinoma, 8% with other liver malignancy, 28% with biliary malignancy, and 5% of living donor liver transplantation donors. Using multiple logistic regression, independent risk factors associated with major complications were operative blood loss of 1000 mL or greater for hepatocellular carcinoma and total bilirubin level of 1.0 mg/dL or greater (>or=17 micro mol/L) and operative time greater than 6 hours for other liver malignancy. No independent factors associated with major complications were identified for biliary malignancy or for living donor liver transplantation donors among the variables investigated in this study. CONCLUSIONS Liver resection can be performed without mortality provided that it is carried out in a high-volume medical center by well-trained hepatobiliary surgeons paying meticulous attention to the balance between the liver functional reserve and the volume of liver to be removed.
Subfields: Hepatology, Surgery
View Paper: https://www.semanticscholar.org/paper/119333725bc761b3b760bb34c12e515d6e2e10c4
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Citations in the corpus
- Improving Perioperative Outcome Expands the Role of Hepatectomy in Management of Benign and Malignant Hepatobiliary Diseases: Analysis of 1222 Consecutive Patients From a Prospective Database (2004, background): “In recent years, we have adopted an even more liberal selection criterion and offered right hepatectomy or extended hepatectomy to patients with ICGR-15 up to 20%.22 Our aggressive approach was partly driven by the improving survival results that we have observed in hepatic resection for HCC, even f”
- The “50-50 Criteria” on Postoperative Day 5: An Accurate Predictor of Liver Failure and Death After Hepatectomy (2005, background): “4% in this population of patients, including a large number of major resections with abnormal underlying liver parenchyma, is far from the zero mortality achieved in highly selected groups.(2,25) As shown in the present study, more than 50% of the postoperative deaths occurred after 2 weeks.”
- Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). (2011, result): “Some authors considered the development of clinical symptoms, such as encephalopathy and ascites, in combination with results from liver function tests for the diagnosis of PHLF (Table I).(19-64) Few studies provided a grading of PHLF,(20,28,40,55) and few studies aimed to define PHLF actually ident”