title: [Toward zero mortality in liver resection. Presentation of 200 consecutive cases].
abstract: BACKGROUND
  Liver resection (LR) morbidity and mortality rates have dropped in recent decades. Mortality is now below 5% and morbidity is less than 30%. Our objective was to present a series of 200 LRs without mortality and to analyze the factors that may be related to complications.
  
  
  METHODS
  Between January 1996 and October 2003, 200 LRs were performed in 177 patients. The most common indication was liver metastases in 123 patients (61.5%), primary malignant liver tumors in 27 patients (13.5%), bile duct tumors in 27 patients (13.5%) and benign disease in 23 patients (11.5%). Fifty-one percent of the resections were performed under hemihepatic vascular control and 49% were resections of central segments, segmentary and atypical resections. We studied the association between morbidity and age, sex, previous comorbidity, liver status, indication for surgery, number of resections, major and minor resections, resection extended to other organs, type of vascular occlusion, transfusion requirements, operating time, length of hospital stay and experience of the surgical team.
  
  
  RESULTS
  There was no postoperative mortality. The morbidity rate was 17.5% (35 patients) and the most common complications were biliary (8%). Morbidity was related to transfusion (transfused patients presented more complications) (P < .001). Transfusion was greater in major resections, the first 100 resections and prolonged operations. Among the segmentary resections the Pringle maneuver reduced transfusion requirements but this difference was not statistically significant. Morbidity decreased in the second 100 resections, without significant differences.
  
  
  CONCLUSIONS
  LRs can be performed with low mortality and morbidity. Biliary complications and blood transfusion should be avoided whenever possible.
authors.affiliation: Servicio de Cirugía, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain. rirocam@um.es
authors.forename: Ricardo
authors.initials: R
authors.lastname: Robles
authors.forename: Caridad
authors.initials: C
authors.lastname: Marín
authors.forename: Juan Angel
authors.initials: JA
authors.lastname: Fernández
authors.forename: Pablo
authors.initials: P
authors.lastname: Ramírez
authors.forename: Francisco
authors.initials: F
authors.lastname: Sánchez-Bueno
authors.forename: Dolores
authors.initials: D
authors.lastname: Morales
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Luján
authors.forename: Beatriz
authors.initials: B
authors.lastname: Abellán
authors.forename: María
authors.initials: M
authors.lastname: Ramírez
authors.forename: Pedro
authors.initials: P
authors.lastname: Cascales
authors.forename: Domingo
authors.initials: D
authors.lastname: Pérez
authors.forename: Pascual
authors.initials: P
authors.lastname: Parrilla
mesh_terms: D001650:Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery*; D002277:Carcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery; D015179:Colorectal Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate