title: 2012 Liver resections in the 21st century: we are far from zero mortality.
abstract: OBJECTIVE
  Recent improvements in surgical technique have extended the indications for liver resection. The aims of this study were to assess whether this extension is associated with a changing patient profile and to evaluate how this potential shift has influenced mortality after liver resection in order to define standard expectations for hepatectomy.
  
  
  METHODS
  The characteristics and postoperative outcomes of all patients undergoing elective hepatectomy from 2000 to 2009 were reviewed retrospectively. Multivariate analysis was conducted to determine the factors associated with mortality in the subgroup of patients with malignant disease.
  
  
  RESULTS
  Among the 2012 patients in whom hepatectomies were performed, the percentage of patients operated for malignancy increased from 66.4% in 2000 to 82.3% in 2009 (P < 0.001). These patients experienced higher mortality (4.5% versus 0.7%; P < 0.001), were significantly older, and displayed greater comorbidity and underlying parenchymal disease compared with those with benign lesions. Mortality over the entire study period was 3.5% and was fairly stable, dropping from 3.8% in 2000 to 3.1% in 2009 (P = 0.686). On multivariate analysis, age of >60 years, an American Society of Anesthesiologists score of ≥3, major resection, vascular procedure, severe fibrosis (F3-F4) and steatosis of >30% were associated with increased mortality in patients with malignant disease.
  
  
  CONCLUSIONS
  The profile of patients undergoing liver resection has changed and now includes more high-risk patients with diseased parenchyma undergoing major hepatectomy for malignancy. This change in patient profile is responsible for the stability in mortality rates over the years.
authors: Department of Hepatopancreatobiliary Surgery, Beaujon Hospital, Clichy, France.|Assistance Publique-Hôpitaux de Paris, University Paris 7 Denis Diderot, Paris, France.
authors: Safi
authors: S
authors: Dokmak
authors: Department of Hepatopancreatobiliary Surgery, Beaujon Hospital, Clichy, France.|Assistance Publique-Hôpitaux de Paris, University Paris 7 Denis Diderot, Paris, France.
authors: Fadhel Samir
authors: FS
authors: Ftériche
authors: Department of Hepatopancreatobiliary Surgery, Beaujon Hospital, Clichy, France.|Assistance Publique-Hôpitaux de Paris, University Paris 7 Denis Diderot, Paris, France.
authors: René
authors: R
authors: Borscheid
authors: Department of Hepatopancreatobiliary Surgery, Beaujon Hospital, Clichy, France.|Assistance Publique-Hôpitaux de Paris, University Paris 7 Denis Diderot, Paris, France.
authors: François
authors: F
authors: Cauchy
authors: Department of Hepatopancreatobiliary Surgery, Beaujon Hospital, Clichy, France.|Assistance Publique-Hôpitaux de Paris, University Paris 7 Denis Diderot, Paris, France.
authors: Olivier
authors: O
authors: Farges
authors: Department of Hepatopancreatobiliary Surgery, Beaujon Hospital, Clichy, France.|Assistance Publique-Hôpitaux de Paris, University Paris 7 Denis Diderot, Paris, France.
authors: Jacques
authors: J
authors: Belghiti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures / Q000401:mortality; D005260:Female; D005602:France / Q000453:epidemiology; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008107:Liver Diseases / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D055815:Young Adult