Major Hepatic Resection A 25-Year Experience

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Abstract
Major hepatic resections were performed on 138 patients for a variety of conditions. There was 1 intraoperative death. Including this patient, there were 15 deaths within 30 days of the operation (operative mortality, 10.9%). Important postoperative complications were intraabdominal sepsis (17%), biliary leak (11%), hepatic failure (8%) and hemorrhage (6%). The results of 30 resections for the benign lesions, liver cell adenoma focal nodular hyperplasia, hemangioma and cystadenoma showed no operative mortality and low morbidity. Of 26 patients with hepatocellular carcinoma, 7 died within a month of operation. The cumulative survival of the 26 at 5 yr was 38% and of the 19 who survived the procedure, 51%. Poor survival followed resections for cholangiocarcinoma and mixed tumors. The 5-yr cumulative survival of 22 patients who had colorectal metastases excised was 31%. Apart from a patient with carcinoid, prolonged survival was rare after resection of other secondaries and after en block resections for tumors directly invading the liver. Hepatic resection was of value in the management of some patients with hepatic trauma, Caroli''s disease, liver cysts and intrahepatic stones.