title: Trends in morbidity and mortality after hepatic resection for hepatocellular carcinoma: an institute's experience with 625 patients.
abstract: BACKGROUND
  Despite recent developments in surgery and patient management during the perioperative period, critical complications still developed in a few patients who had hepatic resection for hepatocellular carcinoma (HCC).
  
  
  METHODS
  Six hundred twenty-five consecutive patients who had hepatic resection for HCC were reviewed and operative morbidity and mortality rates assessed.
  
  
  RESULTS
  There were progressive decreases in the surgical blood loss and the rate of blood transfusion (p = 0.0001). Occurrence of ascites and other complications dramatically decreased in the study series (p = 0.0001). Hospital death rate and incidence of postoperative liver failure also decreased from 2.5%, 1.9% (1985 to 1990), 4.4%, 3.2% (1991 to 1996) to 1.9%, 1.4% (1997 to 2002), respectively. Using multiple logistic regression, independent risk factors associated with postoperative complications were found to be the period of operation (odds ratio [OR] = 0.408; p < 0.0001) and alanine aminotransferase > or = 70 IU/L (OR = 2.020; p = 0.0009) over the entire period of this study (1985 to 2002), or the platelet count of < 100 x 10(3)/mm(3) (OR = 4.654; p = 0.0072) and the presence of blood transfusion during operation (OR = 8.249; p = 0.0230) in 1997 to 2002.
  
  
  CONCLUSIONS
  In this series, there has been a decline in surgical blood loss and rate of blood transfusion and in the number of patients with major complications. These results are largely attributable to the adequate selection of surgical candidate and factors aimed at reducing surgical blood loss.
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. taketomi@surg2.med.kyushu-u.ac.jp
authors: Akinobu
authors: A
authors: Taketomi
authors: Dai
authors: D
authors: Kitagawa
authors: Shinji
authors: S
authors: Itoh
authors: Norifumi
authors: N
authors: Harimoto
authors: Yo-ichi
authors: Y
authors: Yamashita
authors: Tomonobu
authors: T
authors: Gion
authors: Ken
authors: K
authors: Shirabe
authors: Mitsuo
authors: M
authors: Shimada
authors: Yoshihiko
authors: Y
authors: Maehara
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000639:trends; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications