肝脏杂志：疾病与移植

Predictors of Postoperative Morbidity after Minor and Major Liver Resections in a Single German Centre

Felix Rückert, Sebastian Zach, Sabrina Kising, Matthias Kuhn, Ulrich Ronellenfitsch, Mirhasan Rahimli, Torsten J Wilhelm, Stefan Post and Marco Niedergethmann

1.1 Background: Hepatic resections are classically subdivided into major and minor resections. These definitions are important for the perioperative management as major resections are associated with a higher incidence of complications like liver failure or bile leakage. However, other perioperative factors might also influence patient outcome. The present study aims to evaluate the significance of major and minor hepatic resection as well as other factors on the postoperative course. For this purpose we analysed data retrospectively from our centre.

1.2 Patients and methods: The study was based on a prospective database of all liver resections performed at the University Hospital Mannheim between January 1998 and December 2010 (a total of 627 consecutive liver resections). In these patients 135 major hepatectomies, and 192 minor resections were performed. Wedge resections were excluded from analysis. Variables independently associated with the occurrence of complications were identified using a binary regression analysis model.

1.3 Results: 186 (56.9%) of the patients were male, the mean age of all patients was 61.9 years (SD 11.5). The rate of patients with postoperative liver failure was 3.4% and 30-day mortality was 5.5%. Mean length of stay was 15.6 days. Surgical and non-specific complications were significantly more frequent in major hepatectomies. However, we found that the performed procedure was no independent risk factor for the incidence of specific complications, liver failure and mortality. Multivariate analysis could reveal different other independent risk factors for the incidence of complications and mortality. Among these were ASA classification, low preoperative serum albumin and elevated preoperative levels of ALAT.

1.4 Conclusion: Our data suggests that quality and quantity of complications does not only depend on the extent of the performed procedure. Our analysis identified additional independent risk factors. These risk factors, as well as the performed procedure, should be considered in the perioperative management.