Criteria for safe hepatic resection

doi:10.1016/S0002-9610(99)80227-X

The American Journal of Surgery

Volume 169, Issue 6, June 1995, Pages 589-594

https://doi.org/10.1016/S0002-9610(99)80227-X Get rights and content

Background

To lower morbidity after hepatic resection, the authors examined the influence of predictor variables including: age, sex, preoperative risk factors, serum total bilirubin level, plasma retention rate of indocyanine green at 15 minutes, underlying liver disease, operative blood loss, operation time, amount of whole blood transfused, vascular occlusion time, surgical procedure employed, and extent of hepatic resection.

Patients and methods

Between January 1990 and December 1992, 172 patients underwent hepatic resection based on our own criteria for hepatectomy, including the presence or absence of ascites, serum total bilirubin level, and the plasma retention rate of indocyanine green at 15 minutes in patients with chronic liver disease. The morbidity rate was 37.2%, and the hospital and operative mortality rates were 2.3% and 0.6%.

Results

The multiple logistic model revealed that the risk of morbidity was increased by longer operation time, major hepatic resection, and preoperative cardiovascular disease.

Conclusions

Shortening the operation time without increasing operative blood loss and further modalities for making major hepatectomy safer are future problems to be addressed.

References (35)

AdsonMA et al.
Resection of primary solid hepatic tumor
Am J Surg
(1981)
JoishyS et al.
Hepatic resection for malignant tumors of the liver: essentials for a unified surgical approach
Am J Surg
(1980)
StimpsonREJ et al.
Factors affecting the morbidity of elective liver resection
Am J Surg
(1987)
ThompsonH et al.
Major hepatic resection. A 25-year experience
Ann Surg
(1983)
MakuuchiM et al.
Safety of hemihepatic vascular occlusion during resection of the liver
Surgery
(1987)
MakuuchiM et al.
Ultrasonically guided subsegmentectomy
Surgery
(1985)
MakuuchiM et al.
Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report
Surgery
(1990)
LeeNW et al.
The surgical management of primary carcinoma of the liver
Word J Surg
(1982)
BengmarkS et al.
Primary cancer of the liver: improvement in sight?
World J Surg
(1982)
BoermaEJ
Research into the results of resection of hilar bile duct cancer
Surgery
(1990)

NordlingerB et al.

Hepatic resection for colorectal liver metastasis

Ann Surg

(1987)

HolmA et al.

Hepatic resection of metastasis from colorectal carcinoma

Ann Surg

(1989)

YamanakaN et al.

A multiple regression equation for prediction of post-hepatectomy liver failure

Ann Surg

(1984)

NoguchiT et al.

Preoperative estimation of surgical risk of hepatectomy in cirrhotic patients

Hepatogastroenterology

(1990)

MakuuchiM et al.

Strategy of surgical treatment for hepatocellular carcinoma with liver cirrhosis [In Japanese]

Gekasinryo

(1987)

HealeyJE

Clinical anatomic aspects of radical hepatic surgery

J Internat Coll Surg

(1954)

PringleJH

Notes on the arrest of hepatic hemorrhage due to trauma

Ann Surg

(1908)

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^*: This work was supported in part by a Grant-in-Aid for the Comprehensive 10-year Strategy for Cancer Control, the Cancer Research Fund of the Ministry of Health and Welfare of Japan, and grants from the Japanese Foundation for Promotion of Cancer Research.

View full text

Criteria for safe hepatic resection*

Background

Patients and methods

Results

Conclusions

Am J Surg

Am J Surg

Am J Surg

Major hepatic resection. A 25-year experience

Ann Surg

Safety of hemihepatic vascular occlusion during resection of the liver

Surgery

Ultrasonically guided subsegmentectomy

Surgery

Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report

Surgery

The surgical management of primary carcinoma of the liver

Word J Surg

Primary cancer of the liver: improvement in sight?

World J Surg

Research into the results of resection of hilar bile duct cancer

Surgery

Hepatic resection for colorectal liver metastasis

Ann Surg

Hepatic resection of metastasis from colorectal carcinoma

Ann Surg

A multiple regression equation for prediction of post-hepatectomy liver failure

Ann Surg

Preoperative estimation of surgical risk of hepatectomy in cirrhotic patients

Hepatogastroenterology

Strategy of surgical treatment for hepatocellular carcinoma with liver cirrhosis [In Japanese]

Gekasinryo

Clinical anatomic aspects of radical hepatic surgery

J Internat Coll Surg

Notes on the arrest of hepatic hemorrhage due to trauma

Ann Surg