title: Redefining major hepatic resection for colorectal liver metastases: Analysis of 1111 liver resections.
abstract: BACKGROUND
  A major hepatic resection is currently defined as resection of 3 or more segments. The aim of this study was to analyse the post-operative morbidity and mortality of hepatic resections in relation to the number of segments excised.
  
  
  METHODS
  From January 2000 to December 2010, 1111 liver resections were performed for colorectal liver metastases (CRLM). Data were collected from a prospectively maintained database and analysed according to the extent of resection performed.
  
  
  RESULTS
  457 patients had 1-2, 362 had 3-4 and 292 had 5-6 segments resected respectively. In comparing 1-4 vs. 5-6 segments, overall morbidity (16.7% vs 40.7%; p < 0.001), hepatic failure (0.6% vs 10.6%; p < 0.001); mean hospital stay (8 vs 13.5 days; p = 0.000), mean ICU stay (4.4 vs 6.5 days; p = 0.01), 60-day mortality (0.7% vs 3.4%; p = 0.002), and 90-day mortality (0.7% vs 3.4%; p = 0.002) were significantly different. When analysing the 3-4 vs 5-6 segment resections, morbidity (21.8% vs 40.7%; p < 0.001), hepatic failure (1.4% vs 10.6%; p = 0.000), 60-day mortality (0.7% vs 3.4%; p = 0.002), and 90-days mortality (0.8% vs 3.4%; p = 0.023) remained statistically significant.
  
  
  CONCLUSIONS
  Differences in outcome would suggest a revision of the current classification. Only when 5 or more segments are excised for CRLM should a liver resection be considered "major".
authors.affiliation: Departments of Hepatobiliary and Transplant Surgery, St James' University Hospital, Leeds, LS9 7TF, UK; Department of General Surgery, Division of Hepato-Pancreato-Biliary Surgery, Digestive Disease Institute, A100 Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
authors.forename: Gareth
authors.initials: G
authors.lastname: Morris-Stiff
authors.affiliation: Departments of Hepatobiliary and Transplant Surgery, St James' University Hospital, Leeds, LS9 7TF, UK.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Marangoni
authors.affiliation: Departments of Hepatobiliary and Transplant Surgery, St James' University Hospital, Leeds, LS9 7TF, UK.
authors.forename: Abdul
authors.initials: A
authors.lastname: Hakeem
authors.affiliation: Departments of Hepatobiliary and Transplant Surgery, St James' University Hospital, Leeds, LS9 7TF, UK.
authors.forename: Shahid G
authors.initials: SG
authors.lastname: Farida
authors.affiliation: Departments of Hepatobiliary and Transplant Surgery, St James' University Hospital, Leeds, LS9 7TF, UK.
authors.forename: Dhanwant
authors.initials: D
authors.lastname: Gomez
authors.affiliation: Departments of Hepatobiliary and Transplant Surgery, St James' University Hospital, Leeds, LS9 7TF, UK.
authors.forename: Giles J
authors.initials: GJ
authors.lastname: Toogood
authors.affiliation: Departments of Hepatobiliary and Transplant Surgery, St James' University Hospital, Leeds, LS9 7TF, UK.
authors.forename: J Peter A
authors.initials: JP
authors.lastname: Lodge
authors.affiliation: Departments of Hepatobiliary and Transplant Surgery, St James' University Hospital, Leeds, LS9 7TF, UK. Electronic address: raj.prasad@leedsth.nhs.uk.
authors.forename: K
authors.initials: K
authors.lastname: Raj Prasad
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology; D016208:Databases, Factual; D005260:Female; D006498:Hepatectomy / Q000145:classification* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Colorectal liver metastases; Liver failure; Morbidity; Resection