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Personal experience with 411 hepatic resections

Iwatsuki, S and Starzl, TE (1988) Personal experience with 411 hepatic resections. Annals of Surgery, 208 (4). 421 - 434. ISSN 0003-4932

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Abstract

Over a 24-year period, 411 partial hepatic resections were performed: 142 right or left trisegmentectomies, 158 lobectomies, 25 segmentectomies, and 86 local excisions. The operations were performed for benign lesions in 182 patients, for primary hepatic malignancies in 106, and for hepatic metastases in 123, including 90 from colorectal cancers. The 30-day (operative) mortality rate was 3.2%, and there were an additional six late deaths (1.5%) due to hepatic failure caused by the resection. The highest operative mortality rate (6.3%) resulted from the trisegmentectomies, but this merely reflected the extent of the disease being treated. A mortality rate of 8.5% for patients with primary hepatic malignancy was associated not only with the extensiveness of lesions, but also with cirrhosis in the remaining liver fragment. There was no mortality for 123 patients with metastatic disease, 100 patients with cavernous hemangioma, 22 with liver cell adenoma, 17 with focal nodular hyperplasia, 16 with congenital cystic disease, and five with hydatid cysts. Trauma, pre-existing iatrogenic injury, and cirrhosis were the only conditions that had lethal portent in patients with benign disease. Furthermore, patients with benign disease who survived operation had minimal liability from recurrence of their original disease an none from the resection per se. By contrast, tumor recurrence dominated the actuarial survival rates for cancer patients, which at 1 and 5 years were 68.5% and 31.9%, respectively, after resection for primary hepatic malignancy, and 84.2% and 29.5%, respectively, for hepatic metastases. In this report, the expanding role of partial hepatectomy in the treatment of liver disease was emphasized, as well as the need for considering, in some cases, the alternative of total hepatectomy and liver replacement.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Iwatsuki, S
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 January 1988
Date Type: Publication
Journal or Publication Title: Annals of Surgery
Volume: 208
Number: 4
Page Range: 421 - 434
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0003-4932
Other ID: uls-drl:31735062130350, Starzl CV No. 885
Date Deposited: 08 Apr 2010 17:15
Last Modified: 14 Oct 2017 11:55
URI: http://d-scholarship.pitt.edu/id/eprint/4271

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