Predictors of Perioperative outcome after Hepatectomy : A Prospective Analysis.

Vimalraj, V (2007) Predictors of Perioperative outcome after Hepatectomy : A Prospective Analysis. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION : Evolution of surgical techniques in partial hepatectomy has enabled the procedure to be performed with operative mortality rate of less than 5% in highvolume centers in recent years. Before the 1980s, hepatic resection was typically associated with a mortality rate of greater than 10%. Better understanding of the segmental liver anatomy and refined surgical techniques in controlling hemorrhage are the 2 most important factors that have contributed to the improved perioperative outcome of hepatectomy. Another important factor is the better selection of patients in terms of liver function reserve and comorbid conditions, which helps to reduce mortality from liver failure and other severe postoperative complications such as pneumonia. Finally, the concentration of hepatic resection in experienced hepatobiliary centers is also a critical factor. Recent studies from other countries have demonstrated that a high hospital mortality rate of around 10% is still being observed in low-volume hospitals, whereas the hospital mortality rate in high-volume centers is less than 5%.The improved safety of hepatic resection has led to the broadening of the indications of hepatectomy in patients with normal liver. partial hepatectomy in combination with other major procedures is now performed with greater frequency. AIMS AND OBJECTIVES : The current study aims to analyze the trends in perioperative outcome of 40 consecutive patients with hepatectomy for various benign or malignant hepatobiliary diseases in a specialized hepatobiliary center over a period between August 2004 and March 2007, with a particular reference to the prevalence of underlying risk conditions such as impaired liver function reserve, advanced age, and presence of comorbid illnesses. METHODS : During a period from August, 2004, to March, 2007, 40 consecutive patients underwent elective hepatic resection for benign or malignant hepatobiliary diseases at the Department of Surgical Gastroenterology, Government Stanley Hospital, Chennai, Tamilnadu. The hepatectomies were performed by a surgical team specialized in hepatobiliary surgery. All patients had ultrasonography and contrast computed tomography (CT) scan or magnetic resonance imaging to evaluate the liver or biliary pathology. Assessment of liver function was based on Child’s classification, liver biochemistry, and coagulation profile. In patients with hepatocellular carcinoma (HCC), preoperative biopsy is not routinely performed if the lesion is operable. CT volumetry was used to aid assessment of liver function reserve. CONCLUSION : This study demonstrated that perioperative outcome has improved despite extending the indication of hepatectomy to more high-risk patients. Hence, the role of hepatectomy in the management of benign and malignant hepatobiliary diseases can be expanded. Concomitant comorbid illness, hyperbilirubinemia, hypoalbuminemia, prolonged prothrombin time, major hepatic resection, concomitant extra hepatic procedure, Pringles maneuver, blood loss of more than1 L, need for perioperative blood transfusion and fresh frozen plasma more than six units and presence of intraoperative hypotension were associated with increased morbidity, whereas presence of comorbid illness, prolonged prothrombin time, concomitant extra hepatic procedures and operative blood loss of more than 1 litre, was associated with increased hospital mortality. Reduced perioperative blood loss hence reduction in transfusion requirement is a main contributory factor for the improved outcome, and further effort should be directed toward improving surgical techniques to achieve bloodless hepatic resection.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Predictors ; Perioperative Outcome ; Hepatectomy ; Prospective Analysis.
Subjects: MEDICAL > Surgical Gastroenterology and Proctology
Depositing User: Kambaraman B
Date Deposited: 28 Jul 2017 02:52
Last Modified: 28 Jul 2017 02:52
URI: http://repository-tnmgrmu.ac.in/id/eprint/2239

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