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Article: Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: Analysis of 1222 consecutive patients from a prospective database

TitleImproving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: Analysis of 1222 consecutive patients from a prospective database
Authors
Issue Date2004
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com
Citation
Annals Of Surgery, 2004, v. 240 n. 4, p. 698-710 How to Cite?
AbstractObjective: To assess the trends in perioperative outcome of hepatectomy for hepatobiliary diseases. Methods: Data of 1222 consecutive patients who underwent hepatectomy for hepatobiliary diseases from July 1989 to June 2003 in a tertiary institution were collected prospectively. Perioperative outcome of patients in the first (group I) and second (group II) halves of this period was compared. Factors associated with morbidity and mortality were analyzed. Results: Diagnoses included hepatocellular carcinoma (n = 734), other liver cancers (n = 257), extrahepatic biliary malignancies (n = 43), hepatolithiasis (n = 101), benign liver tumors (n = 61), and other diseases (n = 26). The majority of patients (61.8%) underwent major hepatectomy of ≥3 segments. The overall hospital mortality and morbidity were 4.9% and 32.4%, respectively. The number of hepatectomies increased from 402 in group I to 820 in group II, partly as a result of more liberal patient selection. Group II had more elderly patients (P = 0.006), more patients with comorbid illnesses (P = 0.001), and significantly worse liver function. Nonetheless, group II had lower blood loss (median 750 versus 1450 mL, P < 0.001), perioperative transfusion (17.3% versus 67.7%, P < 0.001), morbidity (30.0% versus 37.3%, P = 0.012), and hospital mortality (3.7% versus 7.5%, P = 0.004). On multivariate analysis, hypoalbuminemia, thrombocytopenia, elevated serum creatinine, major hepatic resection, and transfusion were the significant predictors of hospital mortality, whereas concomitant extrahepatic procedure, thrombocytopenia, and transfusion were the predictors of morbidity. Conclusions: Perioperative outcome has improved despite extending the indication of hepatectomy to more high-risk patients. The role of hepatectomy in the management of hepatobiliary diseases can be expanded. Reduced perioperative transfusion is the main contributory factor for improved outcome.
Persistent Identifierhttp://hdl.handle.net/10722/49346
ISSN
2015 Impact Factor: 8.569
2015 SCImago Journal Rankings: 4.503
PubMed Central ID
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorPoon, RTen_HK
dc.contributor.authorFan, STen_HK
dc.contributor.authorLo, CMen_HK
dc.contributor.authorLiu, CLen_HK
dc.contributor.authorLam, CMen_HK
dc.contributor.authorYuen, WKen_HK
dc.contributor.authorYeung, Cen_HK
dc.contributor.authorWong, Jen_HK
dc.contributor.authorNagorney, DMen_HK
dc.contributor.authorHenderson, JMen_HK
dc.contributor.authorPitt, HAen_HK
dc.contributor.authorPoon, RTen_HK
dc.date.accessioned2008-06-12T06:39:59Z-
dc.date.available2008-06-12T06:39:59Z-
dc.date.issued2004en_HK
dc.identifier.citationAnnals Of Surgery, 2004, v. 240 n. 4, p. 698-710en_HK
dc.identifier.issn0003-4932en_HK
dc.identifier.urihttp://hdl.handle.net/10722/49346-
dc.description.abstractObjective: To assess the trends in perioperative outcome of hepatectomy for hepatobiliary diseases. Methods: Data of 1222 consecutive patients who underwent hepatectomy for hepatobiliary diseases from July 1989 to June 2003 in a tertiary institution were collected prospectively. Perioperative outcome of patients in the first (group I) and second (group II) halves of this period was compared. Factors associated with morbidity and mortality were analyzed. Results: Diagnoses included hepatocellular carcinoma (n = 734), other liver cancers (n = 257), extrahepatic biliary malignancies (n = 43), hepatolithiasis (n = 101), benign liver tumors (n = 61), and other diseases (n = 26). The majority of patients (61.8%) underwent major hepatectomy of ≥3 segments. The overall hospital mortality and morbidity were 4.9% and 32.4%, respectively. The number of hepatectomies increased from 402 in group I to 820 in group II, partly as a result of more liberal patient selection. Group II had more elderly patients (P = 0.006), more patients with comorbid illnesses (P = 0.001), and significantly worse liver function. Nonetheless, group II had lower blood loss (median 750 versus 1450 mL, P < 0.001), perioperative transfusion (17.3% versus 67.7%, P < 0.001), morbidity (30.0% versus 37.3%, P = 0.012), and hospital mortality (3.7% versus 7.5%, P = 0.004). On multivariate analysis, hypoalbuminemia, thrombocytopenia, elevated serum creatinine, major hepatic resection, and transfusion were the significant predictors of hospital mortality, whereas concomitant extrahepatic procedure, thrombocytopenia, and transfusion were the predictors of morbidity. Conclusions: Perioperative outcome has improved despite extending the indication of hepatectomy to more high-risk patients. The role of hepatectomy in the management of hepatobiliary diseases can be expanded. Reduced perioperative transfusion is the main contributory factor for improved outcome.en_HK
dc.format.extent388 bytes-
dc.format.mimetypetext/html-
dc.languageengen_HK
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.comen_HK
dc.relation.ispartofAnnals of Surgeryen_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subject.meshBiomedical Researchen_HK
dc.subject.meshFamily Practice - trendsen_HK
dc.subject.meshForecastingen_HK
dc.subject.meshHumansen_HK
dc.titleImproving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: Analysis of 1222 consecutive patients from a prospective databaseen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0003-4932&volume=240&issue=4&spage=698&epage=710&date=2004&atitle=Improving+perioperative+outcome+expands+the+role+of+hepatectomy+in+management+of+benign+and+malignant+hepatobiliary+diseases:+analysis+of+1222+consecutive+patients+from+a+prospective+databaseen_HK
dc.identifier.emailPoon, RT: poontp@hku.hken_HK
dc.identifier.emailFan, ST: stfan@hku.hken_HK
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.emailPoon, RT: poontp@hku.hken_HK
dc.identifier.authorityPoon, RT=rp00446en_HK
dc.identifier.authorityFan, ST=rp00355en_HK
dc.identifier.authorityLo, CM=rp00412en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.identifier.authorityPoon, RT=rp00446en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1097/01.sla.0000141195.66155.0cen_HK
dc.identifier.pmid15383797-
dc.identifier.pmcidPMC1356471en_HK
dc.identifier.scopuseid_2-s2.0-4644258425en_HK
dc.identifier.hkuros94872-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-4644258425&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume240en_HK
dc.identifier.issue4en_HK
dc.identifier.spage698en_HK
dc.identifier.epage710en_HK
dc.identifier.isiWOS:000224105100027-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridPoon, RT=7103097223en_HK
dc.identifier.scopusauthoridFan, ST=7402678224en_HK
dc.identifier.scopusauthoridLo, CM=7401771672en_HK
dc.identifier.scopusauthoridLiu, CL=7409789712en_HK
dc.identifier.scopusauthoridLam, CM=36799183200en_HK
dc.identifier.scopusauthoridYuen, WK=7102761292en_HK
dc.identifier.scopusauthoridYeung, C=26531966700en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK
dc.identifier.scopusauthoridNagorney, DM=35400419300en_HK
dc.identifier.scopusauthoridHenderson, JM=7402926760en_HK
dc.identifier.scopusauthoridPitt, HA=7103213587en_HK
dc.identifier.scopusauthoridPoon, RT=7103097223en_HK

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