Zero mortality in more than 300 hepatic resections: validity of preoperative volumetric analysis.
OBJECTIVE
We reviewed a series of patients who underwent hepatic resection at our institution, to investigate the risk factors for postoperative complications after hepatic resection of liver tumors and for procurement of living donor liver transplantation (LDLT) grafts.


METHODS
Between April 2004 and August 2007, we performed 304 hepatic resections for liver tumors or to procure grafts for LDLT. Preoperative volumetric analysis was done using 3-dimensional computed tomography (3D-CT) prior to major hepatic resection. We compared the clinicopathological factors between patients with and without postoperative complications.


RESULTS
There was no operative mortality. According to the 3D-CT volumetry, the mean error ratio between the actual and the estimated remnant liver volume was 13.4%. Postoperative complications developed in 96 (31.6%) patients. According to logistic regression analysis, histological liver cirrhosis and intraoperative blood loss >850 mL were significant risk factors of postoperative complications after hepatic resection.


CONCLUSIONS
Meticulous preoperative evaluation based on volumetric analysis, together with sophisticated surgical techniques, achieved zero mortality and minimized intraoperative blood loss, which was classified as one of the most significant predictors of postoperative complications after major hepatic resection.
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. itoshin@surg2.med.kyushu-u.ac.jp
Shinji
S
Itoh
Ken
K
Shirabe
Akinobu
A
Taketomi
Kazutoyo
K
Morita
Norifumi
N
Harimoto
Eiji
E
Tsujita
Keishi
K
Sugimachi
Yo-Ichi
Y
Yamashita
Tomonobu
T
Gion
Yoshihiko
Y
Maehara
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000556:secondary / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000166:cytology / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009929:Organ Size; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D015996:Survival Rate; D009927:Tissue and Organ Procurement / Q000379:methods*; D014463:Ultrasonography; D055815:Young Adult