Langenbeck's archives of surgery · 2026
Incidence, patterns and management of complications (90-day-analysis) after liver surgery - a single center experience with 3177 consecutive hepatic resections.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Tripke Verena, Bartsch Fabian, Weinmann Arndt, Huber Tobias, Griemert Eva-Verena, Pitton Michael B, Baumgart Janine, Mittler Jens, Lang Hauke
Аннотация
PURPOSE: Despite recent advances in surgical techniques and perioperative management, liver surgery is still associated with perioperative morbidity and mortality. This study aims to investigate the spectrum, risk factors and management of postoperative complications.
METHODS: All patients who underwent liver resection between 01/2008 until 12/2023 were identified from a prospective institutional database. The data was analyzed regarding postoperative morbidity and mortality rates.
RESULTS: We identified 3 177 liver resections including 1 345 (42.3%) major hepatectomies (≥ 3 segments). Complications occurred in 1 530 (48.2%). Of these, 460 (14.5%) were grade IIIa, 133 (4.2%) grade IIIb, 118 (3.7%) grade IVa, 13 grade IVb and 111 (3.5%) grade V. A total of 1 158 reinterventions were performed including 256 reoperations, 61 s operative revisions, 109 endoscopic procedures and 732 percutaneous interventions. In multivariate analysis age (p < 0.001), need for hepaticojejunostomy (p < 0.001), duration of operation (p = 0.001), and intraoperative blood transfusion (p < 0.001) were independent risk factors for mortality. Operative revision was associated with an increased mortality rate (26.6% vs. 1.5%, p < 0.001).
CONCLUSION: The need for operative revision marked a subgroup with particularly poor outcome, emphasizing the importance of early detection, minimally invasive complication management whenever feasible, and careful risk stratification in complex liver surgery. Operative revision should be reserved for cases that cannot be managed successfully by intervention or when inevitable.
METHODS: All patients who underwent liver resection between 01/2008 until 12/2023 were identified from a prospective institutional database. The data was analyzed regarding postoperative morbidity and mortality rates.
RESULTS: We identified 3 177 liver resections including 1 345 (42.3%) major hepatectomies (≥ 3 segments). Complications occurred in 1 530 (48.2%). Of these, 460 (14.5%) were grade IIIa, 133 (4.2%) grade IIIb, 118 (3.7%) grade IVa, 13 grade IVb and 111 (3.5%) grade V. A total of 1 158 reinterventions were performed including 256 reoperations, 61 s operative revisions, 109 endoscopic procedures and 732 percutaneous interventions. In multivariate analysis age (p < 0.001), need for hepaticojejunostomy (p < 0.001), duration of operation (p = 0.001), and intraoperative blood transfusion (p < 0.001) were independent risk factors for mortality. Operative revision was associated with an increased mortality rate (26.6% vs. 1.5%, p < 0.001).
CONCLUSION: The need for operative revision marked a subgroup with particularly poor outcome, emphasizing the importance of early detection, minimally invasive complication management whenever feasible, and careful risk stratification in complex liver surgery. Operative revision should be reserved for cases that cannot be managed successfully by intervention or when inevitable.