title: A standard definition of major hepatectomy: resection of four or more liver segments.
abstract: BACKGROUND
  While commonly used to describe liver resections at risk for post-operative complications, no standard definition of 'major hepatectomy' exists. The objective of the present retrospective study is to specify the extent of hepatic resection that should describe a major hepatectomy.
  
  
  METHODS
  Demographics, diagnoses, surgical treatments and outcomes from patients who underwent a liver resection at two high-volume centres were reviewed.
  
  
  RESULTS
  From 2002 to 2009, 1670 patients underwent a hepatic resection. Post-operative mortality and severe, overall and hepatic-related morbidity occurred in 4.4%, 29.7%, 41.6% and 19.3% of all patients. Mortality (7.4% vs. 2.7% vs. 2.6%) and severe (36.7% vs. 24.7% vs. 24.1%), overall (49.3% vs. 40.6% vs. 35.9%) and hepatic-related (25.6% vs. 16.4% vs. 15.2%) morbidity were more common after resection of four or more liver segments compared with after three or after two or fewer segments (all P < 0.001). There were no significant differences in any post-operative outcome after resection of three and two or fewer segments (all P > 0.05). On multivariable analysis, resection of four or more liver segments was independently associated with post-operative mortality and severe, overall, and hepatic-related morbidity (all P < 0.01).
  
  
  CONCLUSIONS
  A major hepatectomy should be defined as resection of four or more liver segments.
authors.affiliation: University of Pittsburgh Medical Center, Liver Cancer Center, Pittsburgh, PA 15213-2582, USA. reddysk@upmc.edu
authors.forename: Srinevas K
authors.initials: SK
authors.lastname: Reddy
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Barbas
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Turley
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Steel
authors.forename: Allan
authors.initials: A
authors.lastname: Tsung
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
authors.forename: David A
authors.initials: DA
authors.lastname: Geller
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Clary
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D004067:Digestive System Neoplasms / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality*; D006801:Humans; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies