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John D. Papadimitriou, MD; Alex C. Fotopoulos, MD; Andreas A. Prahalias, MD; John G. Vassiliou, MD; Lila J. Papadimitriou, MD

Arch Surg. 2001;136:1307-1313.

Hypothesis  Relatively high morbidity rates remain problematic in hepatic resection for malignant neoplasms. Technological innovations coupled with surgical expertise can ameliorate morbidity and mortality rates.

Design  Medical records survey.

Setting  Tertiary care university hospital.

Patients  Five hundred one patients underwent liver resection at our hospital from March 1, 1988, through November 30, 1999. Three hundred twenty-one patients (64.1%) had primary carcinoma, whereas 180 (35.9%) had metastatic disease, mainly colorectal secondary disease (83.3%). Morbidity and mortality rates were compared with those of a previous series in the same setting.

Main Outcome Measures  Special attention was paid to the impact of new technology (eg, newer imaging techniques, ultrasonic aspiration, intraoperative ultrasonography, argon beam coagulation, and autotransfusion) and improved anesthetic and surgical management on mortality and morbidity rates.

Results  Five patients died after liver resection and 93 patients had various complications, representing mortality and morbidity rates of 1.0% and 18.6%, respectively. These results compare favorably with the results of a previous unpublished series (mortality, 5/55 [9.1%]; morbidity, 28/55 [50.9%]). Intraoperative ultrasonography resulted in a change in operative strategy in 7 (17.5%) of a recent group of 40 patients.

Conclusions  Morbidity after major hepatic resection for malignancy can be reduced considerably by applying newer technologies to preoperative and intraoperative decision making. Advanced technology also assists in reducing intraoperative risk by minimizing bleeding during resection of the hepatic parenchyma.

From the Second Academic Department of Surgery, Athens University, Aretaieon Hospital, Athens, Greece.

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