title: Hepatic parenchymal preservation surgery: decreasing morbidity and mortality rates in 4,152 resections for malignancy.
abstract: BACKGROUND
  Liver resection is used to treat primary and secondary malignancies. Historically, these procedures were associated with significant complications, which may affect cancer-specific outcomes. This study analyzed the changes in morbidity and mortality after hepatic resection over time.
  
  
  METHODS
  Records of all patients undergoing liver resection for a malignant diagnosis from 1993 to 2012 at Memorial Sloan Kettering were analyzed. Patients were divided into early (1993 to 1999), middle (2000 to 2006), and recent (2007 to 2012) eras. Major hepatectomy was defined as resection of 3 or more segments. Univariate and multivariate analyses were made with t-tests or Mann-Whitney tests.
  
  
  RESULTS
  There were 3,875 patients who underwent 4,152 resections for malignancy. The most common diagnosis was metastatic colorectal cancer (n = 2,476, 64% of patients). Over the study period, 90-day mortality rate decreased from 5% to 1.6% (p < 0.001). Perioperative morbidity decreased from 53% to 20% (p < 0.001). The percentage of major hepatectomies decreased from 66% to 36% (p < 0.001). The rate of perioperative transfusion decreased from 51% to 21% (p < 0.001). The spectrum of perioperative morbidity changed markedly over time, with abdominal infections (43% of complications) overtaking cardiopulmonary complications (22% of complications). Peak postoperative bilirubin (odds ratio [OR] 1.1, p < 0.001), blood loss (OR 1.5, p = 0.001), major hepatectomy (OR 1.3, p = 0.031), and concurrent partial colectomy (OR 2.4, p < 0.001) were independent predictors of perioperative morbidity. The mortality associated with trisectionectomy (6%) and right hepatectomy (3%) remained unchanged over time.
  
  
  CONCLUSIONS
  Morbidity and mortality rates after partial hepatectomy for cancer have decreased substantially as the major hepatectomy rate has dropped. Encouraging parenchymal preservation and preventing abdominal infections are vital for continued improvement of liver resection outcomes.
authors: Department of Hepatopancreatobiliary Surgery, Memorial Sloan Kettering, New York, NY. Electronic address: kinghamt@mskcc.org.
authors: T Peter
authors: TP
authors: Kingham
authors: Department of Hepatopancreatobiliary Surgery, Memorial Sloan Kettering, New York, NY.
authors: Camilo
authors: C
authors: Correa-Gallego
authors: Department of Hepatopancreatobiliary Surgery, Memorial Sloan Kettering, New York, NY.
authors: Michael I
authors: MI
authors: D'Angelica
authors: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering, New York, NY.
authors: Mithat
authors: M
authors: Gönen
authors: Department of Hepatopancreatobiliary Surgery, Memorial Sloan Kettering, New York, NY.
authors: Ronald P
authors: RP
authors: DeMatteo
authors: Department of Hepatopancreatobiliary Surgery, Memorial Sloan Kettering, New York, NY.
authors: Yuman
authors: Y
authors: Fong
authors: Department of Hepatopancreatobiliary Surgery, Memorial Sloan Kettering, New York, NY.
authors: Peter J
authors: PJ
authors: Allen
authors: Department of Hepatopancreatobiliary Surgery, Memorial Sloan Kettering, New York, NY.
authors: Leslie H
authors: LH
authors: Blumgart
authors: Department of Hepatopancreatobiliary Surgery, Memorial Sloan Kettering, New York, NY.
authors: William R
authors: WR
authors: Jarnagin
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods* / Q000706:statistics & numerical data; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009518:New York / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate / Q000639:trends