Trends in Perioperative Outcome After Hepatic Resection: Analysis of 1500 Consecutive Unselected Cases Over 20 Years

Abstract

In Brief Objective: To estimate risk factors affecting the early outcome after hepatic resection in a high volume center specialized in hepatobiliary surgery and to analyze the changing of results during 3 different periods of treatment. Design: Retrospective review. Patients: A series of 1500 consecutive patients who underwent hepatic resection. Methods: Postoperative morbidity and mortality were analyzed in relation to indications for surgery, period of operation, patient characteristics, and intraoperative variables. Patients were classified into 4 groups, according to the indication for surgery: primary liver tumors with cirrhosis (group 1, G1); other liver malignancies (group 2, G2); biliary malignancies (group 3, G3); and benign diseases (group 4, G4). Patients were also divided into 3 groups, according to the year of operation (period 1: June 1985 to October 1993; period 2: November 1993 to September 1999; period 3: October 1999 to September 2007). Results: Overall mortality and morbidity were 3% and 22.5%, respectively. Multivariate analysis revealed that blood transfusions, G1, and additional procedures were associated with an increased risk of postoperative complications, whereas blood transfusions, G1, G3, and extended hepatectomy were associated with an increased risk of postoperative mortality. G1 decreased, whereas G3, extended hepatectomies and additional procedures significantly increased between periods 2 and 3 (P < 0.05). The complication rate was significantly lower in period 2 (18.8%) compared with period 1 (23.8%) and period 3 (24.8%). Similarly, there was a significantly lower mortality rate in period 2 (1.6%) compared with period 1 (3.4%) and period 3 (4%). Conclusions: Slightly worse short-term outcomes in liver surgery were observed in recent years, with a concomitant increase of the aggressiveness of operative strategies. Nevertheless, the present results still justify an aggressive approach in liver resections. In a single-center experience of 1500 hepatectomies, the early outcomes were primarily affected by the presence of cirrhosis, biliary malignancies, extended hepatectomies, additional procedures, and intraoperative blood transfusions, with overall morbidity and mortality rates of 22.5% and 3%. These figures were significantly lower in the intermediate than in the more recent period, where more aggressive operative strategies were adopted, but still justified this approach when considering the natural history of neoplastic diseases.