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2012 Liver resections in the 21st century: we are far from zero mortality

Authors

  • Safi Dokmak,

    1. Department of Hepatopancreatobiliary Surgery, Beaujon Hospital, Clichy, France
    2. Assistance Publique-Hôpitaux de Paris, University Paris 7 Denis Diderot, Paris, France
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  • Fadhel Samir Ftériche,

    1. Department of Hepatopancreatobiliary Surgery, Beaujon Hospital, Clichy, France
    2. Assistance Publique-Hôpitaux de Paris, University Paris 7 Denis Diderot, Paris, France
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  • René Borscheid,

    1. Department of Hepatopancreatobiliary Surgery, Beaujon Hospital, Clichy, France
    2. Assistance Publique-Hôpitaux de Paris, University Paris 7 Denis Diderot, Paris, France
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  • François Cauchy,

    1. Department of Hepatopancreatobiliary Surgery, Beaujon Hospital, Clichy, France
    2. Assistance Publique-Hôpitaux de Paris, University Paris 7 Denis Diderot, Paris, France
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  • Olivier Farges,

    1. Department of Hepatopancreatobiliary Surgery, Beaujon Hospital, Clichy, France
    2. Assistance Publique-Hôpitaux de Paris, University Paris 7 Denis Diderot, Paris, France
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  • Jacques Belghiti

    Corresponding author
    1. Department of Hepatopancreatobiliary Surgery, Beaujon Hospital, Clichy, France
    2. Assistance Publique-Hôpitaux de Paris, University Paris 7 Denis Diderot, Paris, France
    • Correspondence

      Jacques Belghiti, Department of Hepatopancreatobiliary Surgery, Beaujon Hospital, 100 Boulevard de Général Leclerc, 92110 Clichy, France. Tel: + 33 1 40 87 58 95. Fax: + 33 1 40 87 17 24. E-mail: jacques.belghiti@bjn.aphp.fr

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  • This manuscript was presented at the 10th World IHPBA Congress, Paris, 1–5 July 2012.
  • Correction added on 19 March 2013, after first online publication: Title was changed from ‘Liver Resections in the 21st century: we are far from zero mortality.’

Abstract

Objectives

Recent improvements in surgical technique have extended the indications for liver resection. The aims of this study were to assess whether this extension is associated with a changing patient profile and to evaluate how this potential shift has influenced mortality after liver resection in order to define standard expectations for hepatectomy.

Methods

The characteristics and postoperative outcomes of all patients undergoing elective hepatectomy from 2000 to 2009 were reviewed retrospectively. Multivariate analysis was conducted to determine the factors associated with mortality in the subgroup of patients with malignant disease.

Results

Among the 2012 patients in whom hepatectomies were performed, the percentage of patients operated for malignancy increased from 66.4% in 2000 to 82.3% in 2009 (P < 0.001). These patients experienced higher mortality (4.5% versus 0.7%; P < 0.001), were significantly older, and displayed greater comorbidity and underlying parenchymal disease compared with those with benign lesions. Mortality over the entire study period was 3.5% and was fairly stable, dropping from 3.8% in 2000 to 3.1% in 2009 (P = 0.686). On multivariate analysis, age of >60 years, an American Society of Anesthesiologists score of ≥3, major resection, vascular procedure, severe fibrosis (F3–F4) and steatosis of >30% were associated with increased mortality in patients with malignant disease.

Conclusions

The profile of patients undergoing liver resection has changed and now includes more high-risk patients with diseased parenchyma undergoing major hepatectomy for malignancy. This change in patient profile is responsible for the stability in mortality rates over the years.

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