INTRODUCTION :
Evolution of surgical techniques in partial hepatectomy has enabled the
procedure to be performed with operative mortality rate of less than 5% in highvolume
centers in recent years. Before the 1980s, hepatic resection was typically
associated with a mortality rate of greater than 10%. Better understanding of the
segmental liver anatomy and refined surgical techniques in controlling hemorrhage
are the 2 most important factors that have contributed to the improved perioperative
outcome of hepatectomy. Another important factor is the better selection of patients
in terms of liver function reserve and comorbid conditions, which helps to reduce
mortality from liver failure and other severe postoperative complications such as
pneumonia. Finally, the concentration of hepatic resection in experienced
hepatobiliary centers is also a critical factor. Recent studies from other countries have
demonstrated that a high hospital mortality rate of around 10% is still being observed
in low-volume hospitals, whereas the hospital mortality rate in high-volume centers is
less than 5%.The improved safety of hepatic resection has led to the broadening of
the indications of hepatectomy in patients with normal liver. partial hepatectomy in
combination with other major procedures is now performed with greater frequency.
AIMS AND OBJECTIVES :
The current study aims to analyze the trends in perioperative outcome of 40
consecutive patients with hepatectomy for various benign or malignant hepatobiliary
diseases in a specialized hepatobiliary center over a period between August 2004 and
March 2007, with a particular reference to the prevalence of underlying risk
conditions such as impaired liver function reserve, advanced age, and presence of
comorbid illnesses.
METHODS :
During a period from August, 2004, to March, 2007, 40 consecutive patients
underwent elective hepatic resection for benign or malignant hepatobiliary diseases at
the Department of Surgical Gastroenterology, Government Stanley Hospital, Chennai,
Tamilnadu. The hepatectomies were performed by a surgical team specialized in
hepatobiliary surgery.
All patients had ultrasonography and contrast computed tomography (CT)
scan or magnetic resonance imaging to evaluate the liver or biliary pathology.
Assessment of liver function was based on Child’s classification, liver biochemistry,
and coagulation profile. In patients with hepatocellular carcinoma (HCC),
preoperative biopsy is not routinely performed if the lesion is operable. CT volumetry
was used to aid assessment of liver function reserve.
CONCLUSION :
This study demonstrated that perioperative outcome has improved despite
extending the indication of hepatectomy to more high-risk patients. Hence, the role of
hepatectomy in the management of benign and malignant hepatobiliary diseases can
be expanded.
Concomitant comorbid illness, hyperbilirubinemia, hypoalbuminemia,
prolonged prothrombin time, major hepatic resection, concomitant extra hepatic
procedure, Pringles maneuver, blood loss of more than1 L, need for perioperative
blood transfusion and fresh frozen plasma more than six units and presence of
intraoperative hypotension were associated with increased morbidity, whereas
presence of comorbid illness, prolonged prothrombin time, concomitant extra hepatic
procedures and operative blood loss of more than 1 litre, was associated with
increased hospital mortality.
Reduced perioperative blood loss hence reduction in transfusion requirement
is a main contributory factor for the improved outcome, and further effort should be
directed toward improving surgical techniques to achieve bloodless hepatic resection
