Morbidity of major hepatic resections: a 100-case prospective study.
OBJECTIVE
To assess the morbidity and its main risk factors after major hepatic resection.


METHODS
Retrospective study of prospectively collected data.


METHODS
University hospital, France.


METHODS
100 consecutive patients who underwent major hepatic resections, 1989-95.


METHODS
Major hepatic resection, defined as resection involving 3 or more segments according to Couinaud's classification, in all cases.


METHODS
All complications that affected outcome or prolonged hospital stay. Risk factors identified by univariate and multivariate analysis.


RESULTS
45 patients developed at least 1 complication and 7 died. The most common complications were: pleural effusion (n = 21), hepatic failure (n = 12), and ascites (n = 9). Univariate analysis showed that the following variables were significantly related to the morbidity: age >55 years, American Society of Anesthesiologists (ASA) grade II or more, bilirubin >80 micromol/L, alkaline phosphatase activity more than double the reference range, malignant tumours, abnormal liver parenchyma, simultaneous surgical procedures, operative time >4 hours, and perioperative blood transfusion > or =600 ml. The extent of resection did not correlate with postoperative complications. Multivariate analysis showed that volume of blood transfusion > or =600 ml and simultaneous surgical procedures were the most important independent risk factors for complicated outcome.


CONCLUSIONS
The morbidity associated with major hepatic resections remains high, and the main determinants of outcome are intraoperative surgeon-related factors.
Pol
B
B
Department of Surgery, Hôpital de la Conception, Marseille, France.
Campan
P
P
Hardwigsen
J
J
Botti
G
G
Pons
J
J
Le Treut
Y P
YP
D000328:Adult; D000368:Aged; D005260:Female; D005602:France; D006498:Hepatectomy / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology; D007902:Length of Stay; D008107:Liver Diseases / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome