Principle of perioperative management for hepatic resection and education for young surgeons.
OBJECTIVE
An expert technique and special anatomical or physiological knowledge are needed in the field of hepatic surgery compared to other abdominal surgeries. The establishment of basic policy and operative techniques for hepatectomy and stepwise training for young hepatic surgeons are necessary.


METHODS
We scheduled hepatic resection based on the indocyanine green retention rate at 15 minutes and volumetric analysis. Limited resection or preoperative portal vein embolization was often performed.


RESULTS
Between 1994 and December 2005, 338 hepatectomies were performed. Operative procedures included limited or segmental resection in 215 and hemihepatectomy or more extended hepatectomy in 123. Hyperbilirubinemia or hepatic failure after hepatectomy was observed in 15 (4%) and hospital death in 10 (3%). Although death from hepatic failure was observed in 9 of 152 (6%) between 1994 and 1999, the mortality rate has been improved since 2000 (1 of 186 [0.5%]). Senior residents start training with step by step hepatectomy from partial resection to sectionectomy. Hemi-hepatectomy for normal liver is finally permitted after technical consolidation. More complicated hepatectomy must be performed by experienced teaching surgeons.


CONCLUSIONS
Competent operative techniques under experienced surgeons and the achievement of safe resection at each stage are the educational policy for hepatectomy.
Nanashima
Atsushi
A
Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. a-nanasm@net.nagasaki-u.ac.jp
Sumida
Yorihisa
Y
Abo
Takafumi
T
Tanaka
Kenji
K
Takeshita
Hiroaki
H
Hidaka
Shigekazu
S
Yano
Hiroshi
H
Sawai
Terumitsu
T
Obatake
Masayuki
M
Yasutake
Toru
T
Nagayasu
Takeshi
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy / Q000193:education* / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult