Perioperative management of hepatic resection toward zero mortality and morbidity: analysis of 793 consecutive cases in a single institution.
BACKGROUND
The mortality rates associated with hepatectomy are still not zero. Our aim was to define the risk factors for complications and to evaluate our perioperative management.


METHODS
Between 2001 and 2008, 793 consecutive patients (547 men and 246 women; mean age ± SD, 56.1 ± 14.9 years) underwent hepatectomy without gastrointestinal resection and choledocojejunostomy at our center. Of these patients, 354 (44.6%) were positive for the hepatitis B virus surface antigen and/or the hepatitis C virus antibody. We categorized 783 (98.7%) patients as Child-Pugh class A. Major resection (sectionectomy, hemihepatectomy, and extended hemihepatectomy), was performed in 535 patients (67.5%) and re-resection in 81 patients (10.2%).


RESULTS
The median operative time was 345.5 minutes and median blood loss was 360 mL. The rate of red blood cell transfusion was 6.8%. The morbidity rate was 15.6%. Reoperations were performed in 19 patients (2.4%). The mean postoperative hospital stay was 18.4 ± 10.4 days. The in-hospital mortality rate was 0.1% (1 of 793 patients; caused by hepatic failure). The independent relative risk for morbidity was influenced by an operative time of more than 360 minutes, blood loss of more than 400 mL, and serum albumin levels of less than 3.5 g/dL, as determined using multivariate logistic regression analysis.


CONCLUSIONS
Shorter operative times and reduced blood loss were obtained by improving the surgical technique and using new surgical devices and intraoperative management, including anesthesia. Additionally, decision making using our algorithm and perioperative management according to CDC guidelines reduced the morbidity and mortality associated with hepatectomy.
Kamiyama
Toshiya
T
Department of General Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. t-kamiya@med.hokudai.ac.jp
Nakanishi
Kazuaki
K
Yokoo
Hideki
H
Kamachi
Hirofumi
H
Tahara
Munenori
M
Yamashita
Kenichiro
K
Taniguchi
Masahiko
M
Shimamura
Tsuyoshi
T
Matsushita
Michiaki
M
Todo
Satoru
S
D000328:Adult; D000368:Aged; D000465:Algorithms; D003657:Decision Making; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D006521:Hepatitis, Chronic / Q000150:complications; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D008099:Liver / Q000601:surgery*; D008107:Liver Diseases / Q000150:complications / Q000601:surgery; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012307:Risk Factors; D016896:Treatment Outcome