One hundred liver resections including comparison to non-resected liver-mobilized patients.
BACKGROUND
Factors of liver resection associated with postoperative recovery and survival, the modalities that affect survival with resected colorectal carcinoma liver metastases, the comparison of liver function of liver-resected to liver-mobilized but not resected patients, and observation of early liver regeneration volume over time have not been studied prospectively. This study aimed to prospectively analyse these factors.


METHODS
Data were collected prospectively on 100 consecutive liver resections, and 10 liver-mobilized but not resected patients by the Hepatobiliary Unit, University of Melbourne, Austin Campus. Follow-up of patients was 100%.


RESULTS
The factors associated with blood loss were the type of liver resection (P = 0.0001), the length of the operation (P = 0.0001) and a central venous pressure greater than 5 cm of water (P = 0.0008). An inverse correlation existed between blood loss and long-term survival (P = 0.003). The only predictor for a postoperative complication was the length of the operation (P = 0.03): a correlation of moderate significance existed between blood loss and a complication (P = 0.052; confidence interval 0.19-1.17). The 5-year cumulative survival for hepatic resection for colorectal carcinoma Dukes A + B was 55%; there was a significantly better survival of Dukes A + B compared to Dukes C (P = 0.03) and also for those 50 years or older, but this did not depend on whether there were one or more lesions present. Resected patients had a significantly higher alanine transaminase (ALT), total bilirubin and international normalized ratio than non-resected patients, but not albumin, total protein, alkaline phosphatase or aspartate aminotransferase. The serum albumin fall was similar in both groups, which indicated that loss of liver tissue was not the cause. The re-resection rate was 8% without mortality and with low morbidity. Liver volume was restored by 64% (510 +/- 170 cc) by 7 days postoperatively.


CONCLUSIONS
Major hepatic resection can be performed with low mortality, morbidity and short hospital stay, with a 5-year survival for colorectal carcinoma better than 50%. Resection needs to be considered more frequently for curative management. Serum albumin fall is not caused by loss of liver tissue and blood loss can be controlled by central venous pressure manipulation and vascular isolation. Re-resection is a safe and rewarding treatment and needs to be planned at the first resection.
Hardy
K J
KJ
Department of Surgery, University of Melbourne, Austin Campus, Victoria, Australia. surgery@austin.unimelb.edu.au
Fletcher
D R
DR
Jones
R M
RM
D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000473:pathology; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D006801:Humans; D008099:Liver / Q000503:physiopathology*; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D009017:Morbidity; D011446:Prospective Studies; D016019:Survival Analysis