A worldwide survey of the current daily practice in liver surgery.

Mise, Yoshihiro; Mise, Y; Sakamoto, Yoshihiro; Ishizawa, Takeaki; Kaneko, Junichi; Aoki, Taku; Hasegawa, Kiyoshi; Sugawara, Yasuhiko; Kokudo, Norihiro

doi:10.1159/000346225

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A worldwide survey of the current daily practice in liver surgery.

Author(s): Yoshihiro Mise ¹ , Yoshihiro Sakamoto , Takeaki Ishizawa , Junichi Kaneko , Taku Aoki , Kiyoshi Hasegawa , Yasuhiko Sugawara , Norihiro Kokudo

Publication date (Electronic): Jan 2013

Journal: Liver cancer

Publisher: S. Karger AG

Keywords: Laparoscopic hepatectomy, Liver function, Liver resection, Liver volume

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Abstract

Liver resection remains the mainstay of curative treatment for liver malignancies. A variety of preoperative assessments and surgical techniques have improved the short- and long-term outcomes of liver resection in patients with liver tumors. Recently, laparoscopic hepatectomies have been increasingly performed. The aim of the present study is to survey the current practice of liver surgery in high-volume centers in the world.

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One thousand fifty-six hepatectomies without mortality in 8 years.

Hiroshi Imamura, Atsushi Maema, Tadatoshi Takayama … (2003)

Despite improvements in diagnostic and surgical techniques, operative mortality associated with liver resection is still greater than 2% in most of the recent studies. By refining preoperative and postoperative care and surgical skills, liver resection mortality can be decreased to zero. Retrospective cohort study to analyze postoperative morbidity and mortality in 1056 consecutive hepatectomies performed at a single medical center during 8 years. Tertiary referral center. A total of 915 patients who underwent 1056 consecutive hepatic resections: 532 for hepatocellular carcinoma, 262 for other primary and secondary liver malignancies, 57 for biliary tract malignancy, 174 for living donor liver transplantation, and 31 for other benign diseases. Operative mortality and morbidity rates. No operative mortality occurred. Major complications, as defined by postoperative radiologic or surgical intervention, occurred in 3% of patients with hepatocellular carcinoma, 8% with other liver malignancy, 28% with biliary malignancy, and 5% of living donor liver transplantation donors. Using multiple logistic regression, independent risk factors associated with major complications were operative blood loss of 1000 mL or greater for hepatocellular carcinoma and total bilirubin level of 1.0 mg/dL or greater (>or=17 micro mol/L) and operative time greater than 6 hours for other liver malignancy. No independent factors associated with major complications were identified for biliary malignancy or for living donor liver transplantation donors among the variables investigated in this study. Liver resection can be performed without mortality provided that it is carried out in a high-volume medical center by well-trained hepatobiliary surgeons paying meticulous attention to the balance between the liver functional reserve and the volume of liver to be removed.