Trends in perioperative outcome after hepatic resection: analysis of 1500 consecutive unselected cases over 20 years.
OBJECTIVE
To estimate risk factors affecting the early outcome after hepatic resection in a high volume center specialized in hepatobiliary surgery and to analyze the changing of results during 3 different periods of treatment.


METHODS
Retrospective review.


METHODS
A series of 1500 consecutive patients who underwent hepatic resection.


METHODS
Postoperative morbidity and mortality were analyzed in relation to indications for surgery, period of operation, patient characteristics, and intraoperative variables. Patients were classified into 4 groups, according to the indication for surgery: primary liver tumors with cirrhosis (group 1, G1); other liver malignancies (group 2, G2); biliary malignancies (group 3, G3); and benign diseases (group 4, G4). Patients were also divided into 3 groups, according to the year of operation (period 1: June 1985 to October 1993; period 2: November 1993 to September 1999; period 3: October 1999 to September 2007).


RESULTS
Overall mortality and morbidity were 3% and 22.5%, respectively. Multivariate analysis revealed that blood transfusions, G1, and additional procedures were associated with an increased risk of postoperative complications, whereas blood transfusions, G1, G3, and extended hepatectomy were associated with an increased risk of postoperative mortality. G1 decreased, whereas G3, extended hepatectomies and additional procedures significantly increased between periods 2 and 3 (P < 0.05). The complication rate was significantly lower in period 2 (18.8%) compared with period 1 (23.8%) and period 3 (24.8%). Similarly, there was a significantly lower mortality rate in period 2 (1.6%) compared with period 1 (3.4%) and period 3 (4%).


CONCLUSIONS
Slightly worse short-term outcomes in liver surgery were observed in recent years, with a concomitant increase of the aggressiveness of operative strategies. Nevertheless, the present results still justify an aggressive approach in liver resections.
Cescon
Matteo
M
Liver and Multiorgan Transplant Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. matteo.cescon@aosp.bo.it
Vetrone
Gaetano
G
Grazi
Gian Luca
GL
Ramacciato
Giovanni
G
Ercolani
Giorgio
G
Ravaioli
Matteo
M
Del Gaudio
Massimo
M
Pinna
Antonio Daniele
AD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D002648:Child; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality*; D006801:Humans; D007902:Length of Stay; D008107:Liver Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult