A ten-year experience with hepatic resection in 338 patients: evolutions in indications and of operative mortality.
OBJECTIVE
To report changes in indications for, and operative mortality of, elective hepatic resection during the 10 year period 1980-1989.


METHODS
Retrospective study.


METHODS
District hospital.


METHODS
338 consecutive patients who underwent elective hepatic resection.


METHODS
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%).


METHODS
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.
Belghiti
J
J
Department of Digestive Surgery, Hôpital Beaujon, Clichy-Paris, France.
Di Carlo
I
I
Sauvanet
A
A
Uribe
M
M
Fekete
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery; D008107:Liver Diseases / Q000401:mortality / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies