Hepatic resections: changing mortality and morbidity.

Hepatic resections have been associated with high mortality and morbidity; therefore, this procedure was not used frequently. With increasing safety, acceptance of the procedure grew. A review of recent series still reveals a strikingly high incidence of complications. However, in a review of the last 100 hepatic resections performed at Kaiser Permanente Medical Center, Los Angeles, the average blood loss was 1351 mL, (range 90-10,000 mL) with a median of 900 mL. Blood transfusion requirements averaged 1.5 units, with 50 per cent of patients requiring no transfusion, and 80 per cent of patients requiring two units or less. Cirrhosis, present in 15 per cent of our patients, was associated with increased blood loss and morbidity. The use of the Cavitron Ultrasonic Aspirator (CUSA) and the liver clamp have had a major impact on reducing intraoperative blood loss and transfusion requirement. Operative time was significantly reduced from previous reports, to an average of 221 minutes (90 to 410 minutes). Hospital stay averaged 7 days, with a median of 6 days. Both the mortality rate of 2 per cent and the morbidity rate of 22 per cent represent significant improvements. Utilizing modern techniques, hepatic resections can be done with acceptable mortality and mortality, and may lead to its increased application.