title: Elective hepatic resection is feasible and safe in a regional centre.
abstract: BACKGROUND
  Hepatic resectional surgery remains a highly specialized area of general surgery usually reserved for completion at tertiary metropolitan referral centres. Port Macquarie, on the Mid North Coast of New South Wales, is the only regionally based hospital offering surgery of this nature in mainland Australia. The purpose of this study is to review the data for patients undergoing hepatic resectional surgery in this non-metropolitan centre in order to illustrate that these operations can be carried out safely in a regional setting with comparable results to tertiary-level centres.
  
  
  METHODS
  A retrospective review of consecutive patients undergoing elective hepatic resections at Port Macquarie from February 2008 to 31 October 2015 was completed. Pre-morbid patient clinical and demographic factors, histopathological details, post-operative complications, survival and mortality data were all noted.
  
  
  RESULTS
  A total of 66 consecutive elective liver resections were performed during the study period. Metastatic colorectal cancer was the most commonly observed pathology (n = 33, 50.0%). The 90-day mortality was 4.5% (n = 3) whilst 17 patients (n = 17, 25.8%) experienced major complications (Clavien-Dindo grade 3 or 4). The median overall survival following hepatectomy for colorectal metastases was 48 months (95% confidence interval 37-59 months).
  
  
  CONCLUSIONS
  Our study shows excellent morbidity, mortality and survival for hepatic resectional surgery performed in a regional centre and is comparable data to major metropolitan centres. Our study confirms that major hepatic resectional surgery in this setting is safe and effective.
authors.affiliation: Department of General Surgery, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia.|Department of General Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Gray
authors.affiliation: Department of General Surgery, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia.|Department of General Surgery, Port Macquarie Private Hospital, Port Macquarie, New South Wales, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Petrou
authors.affiliation: Department of General Surgery, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia.
authors.forename: Pratik
authors.initials: P
authors.lastname: Rastogi
authors.affiliation: Mid North Coast Cancer Institute, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Begbie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006764:Hospitals, Community; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate
keywords: hepatectomy; hepatopancreaticobiliary surgery; hospitals rural; morbidity; mortality