OBJECTIVE: To report changes in indications for, and operative mortality of, elective hepatic resection during the 10 year period 1980-1989. DESIGN: Retrospective study. SETTING: District hospital. SUBJECTS: 338 consecutive patients who underwent elective hepatic resection. INTERVENTIONS: During the first five years (1980-1984) 99 resections were done, 10 through a right thoracoabdominal incision, and the hepatic pedicle was clamped in 6. During the period 1985-1989 239 resections were done, only 7 (3%) through a thoracoabdominal incision, and the hepatic pedicle was occluded in 197 (82%). MAIN OUTCOME MEASURES: Changes in indications for operation and operative technique, and mortality. RESULTS: Indications for resection in the first period were: benign lesions (n = 39), primary hepatic cancer (n = 30-15 had hepatocellular carcinoma associated with cirrhosis), and metastatic disease (n = 30). Six patients died, five from uncontrollable bleeding during operation. Indications during the second half were: benign lesions (n = 105, 44%), primary hepatic cancer (n = 87, 36%-62 (29%) had hepatocellular carcinoma associated with cirrhosis), and metastatic disease (n = 47, 20%). There was only 1 death during operation (air embolism), and 9 cirrhotic patients died during the postoperative period. CONCLUSIONS: More hepatic resections are being done and the indications are changing, with more patients with cancer and benign tumours being operated on; increasing use of pedicle occlusion has resulted in a significant decrease in uncontrollable operative bleeding; and mortality is still related to the presence of associated cirrhosis.
OBJECTIVE: To report changes in indications for, and operative mortality of, elective hepatic resection during the 10 year period 1980-1989. DESIGN: Retrospective study. SETTING: District hospital. SUBJECTS: 338 consecutive patients who underwent elective hepatic resection. INTERVENTIONS: During the first five years (1980-1984) 99 resections were done, 10 through a right thoracoabdominal incision, and the hepatic pedicle was clamped in 6. During the period 1985-1989 239 resections were done, only 7 (3%) through a thoracoabdominal incision, and the hepatic pedicle was occluded in 197 (82%). MAIN OUTCOME MEASURES: Changes in indications for operation and operative technique, and mortality. RESULTS: Indications for resection in the first period were: benign lesions (n = 39), primary hepatic cancer (n = 30-15 had hepatocellular carcinoma associated with cirrhosis), and metastatic disease (n = 30). Six patients died, five from uncontrollable bleeding during operation. Indications during the second half were: benign lesions (n = 105, 44%), primary hepatic cancer (n = 87, 36%-62 (29%) had hepatocellular carcinoma associated with cirrhosis), and metastatic disease (n = 47, 20%). There was only 1 death during operation (air embolism), and 9 cirrhotic patients died during the postoperative period. CONCLUSIONS: More hepatic resections are being done and the indications are changing, with more patients with cancer and benign tumours being operated on; increasing use of pedicle occlusion has resulted in a significant decrease in uncontrollable operative bleeding; and mortality is still related to the presence of associated cirrhosis.
Authors: José Guilherme Tralhão; Emir Hoti; Bárbara Oliveiros; Ana M Abrantes; M Filomena Botelho; F Castro-Sousa Journal: World J Surg Date: 2009-12 Impact factor: 3.352
Authors: William R Jarnagin; Wilbur Bowne; David S Klimstra; Leah Ben-Porat; Kevin Roggin; Karina Cymes; Yuman Fong; Ronald P DeMatteo; Michael D'Angelica; Jonathan Koea; Leslie H Blumgart Journal: Ann Surg Date: 2005-05 Impact factor: 12.969