Trends in morbidity and mortality of hepatic resection for malignancy. A matched comparative analysis.
OBJECTIVE
The authors define more clearly the trends in morbidity and mortality after hepatic resection for malignant disease in matched patient groups during two discrete time periods.


BACKGROUND
Recent reports have shown improvement in operative morbidity and mortality associated with hepatic resection; however, results often included resections for benign disease and trauma. Furthermore, specific factors contributing to the improvement in operative risks between the last two decades have not been defined.


METHODS
A retrospective matched comparative analysis was conducted of patients with primary and metastatic hepatic malignancy resected with curative intent between two periods (1976 to 1980 and 1986 to 1990). Eighty-one patients met our inclusion criteria in the early period; this group was matched with 81 patients from the latter period by the following four parameters: age, gender, type of malignant disease, and extent of resection. Records of these two patient groups were abstracted for clinical presentation, co-morbid factors, operative techniques, and perioperative morbidity and mortality.


RESULTS
The authors found a significant decrease in operative morbidity, median perioperative transfusion, and length of hospital stay in the latter period (1986 to 1990). The incidence of postoperative subphrenic abscess and intra-abdominal hemorrhage was significantly lower during this period. Operative mortality rate was similar for both periods, 4.9% and 1.2%, respectively (p > 0.05).


CONCLUSIONS
Hepatic resection for malignant disease currently can be performed with a low morbidity and mortality in the hands of trained and experienced hepatic surgeons; operative risks of hepatic resection should not deter its application in the treatment of primary and metastatic malignant disease of the liver.
Tsao
J I
JI
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Loftus
J P
JP
Nagorney
D M
DM
Adson
M A
MA
Ilstrup
D M
DM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D003106:Colon / Q000601:surgery; D003964:Diaphragm / Q000601:surgery; D004322:Drainage; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality*; D006801:Humans; D007415:Intestinal Obstruction / Q000453:epidemiology; D007430:Intraoperative Care; D007902:Length of Stay / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery*; D008168:Lung / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology