Postoperative liver failure is a life-threatening complication after hepatic resection. Because of recent advances in liver surgery technique and a better patient selection, morbidity after hepatic resection has steadily decreased, but its incidence still ranges from 1.2% to 32%. The factors of postoperative liver failure, morbidity and early mortality in major hepatic resection in the modern era should be reevaluated.
STUDY DESIGN:Demographics, extent of resection, liver fuction, ICGR15, liver volumetry, operative and transfusion data, complications, and hospital stay were analyzed for patients undergoing major hepatic resection(no less than bisegmentectomies) from January2013 to September 2013 at RajavithiHospital. Factors associated with morbidity and mortality and trends in preoperative and perioperative variables over the period of study were analyzed.
RESULTS:Of 50 patients who underwent major hepatic resections, 6 patients (14.63%) developed postoperative liver failure after hepatectomy, 18 patients (36%) had morbidity and 2 patients (4%) died within 30 days postoperatively. Amount of segmentectomy was the significant risk factor for postoperative liver failure and 30-day mortality after major hepatectomy. ICGR15, blood transfusion operative time and more than 3 segmentectomies were the significant risk factors for morbidity. The only significant risk factor for morbidity by multivariated analysis were operative time.
CONCLUSIONS:Careful patient selection based on ICGR concurrent with decreasing blood transfusion and decreasing operative time in major hepatectomy cases could help prevent the occurrence of postoperative liver failure, morbidity and 30 day mortality.