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Indications and Results in a National Hospital System From 1988 to 1992

Daniel E. Nadig, MD; Terence P. Wade, MD; Ralph B. Fairchild, MD; Katherine S. Virgo, PhD; Frank E. Johnson, MD

Arch Surg. 1997;132(2):115-119.

Abstract
Objective
To determine the indications for and outcomes of hepatic resection in a US hospital system.

Design
A retrospective study of 444 consecutive hepatic resections (ie, 286 wedge or segmental resections and 158 lobectomies) using computerized medical records.

Setting
All US Department of Veterans Affairs hospitals.

Patients
US veterans (99% men).

Intervention
Major hepatic resection.

Main Outcome Measure
Survival, as determined by the absence of a death record.

Results
One hundred fifty-eight lobectomies or larger resections were recorded (36% of the total); the 30-day operative mortality was 12% for lobectomies and 5% for wedge resections. However, the diagnosis had a greater influence on the operative mortality: 11 (4%) of 275 patients with colorectal metastases, 15 (21%) of 71 patients with hepatomas, 2 (9%) of 23 patients without cancer (but 0 [0%] of 7 patients with hemangiomas), 3 (12%) of 25 patients with cholangiocarcinomas, and 4 (8%) of 50 patients with metastases from other primary cancers. Approximately one third (ie, 92) of the patients who underwent a resection of their colorectal metastases underwent a concurrent colectomy, while the rest of the patients underwent these surgical procedures metachronously. The operative mortality was equal (ie, 4%) for the resection of synchronous vs metachronous colorectal metastases. The mean survival time after the resection of metachronous vs synchronous colorectal metastases was 34 months vs 30 months, respectively, and the projected 5-year survival after either procedure was 26%. The projected 5-year survival was 20% for patients with hepatoma and 8% for patients with cholangiocarcinoma. With uncommon pathologic types, the mean survival time after metastatic resection was longest for those with renal primary tumors (3 patients, 55 months).

Conclusions
Hepatic resection is a safe and effective therapy for colorectal metastases (5-year survival, 26%) and hemangioma; hepatoma resection is dangerous (operative mortality, 21%) but effective (5-year survival, 20%).

Arch Surg. 1997;132:115-119

Author Affiliations
From the Department of Surgery, John Cochran Veterans Affairs Medical Center and St Louis University School of Medicine, St Louis, Mo.

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