IMPROVEMENTS IN LIVER RESECTIVE SURGERY: ANALYSIS ON AN ONCOLOGICAL POPULATION

Introduction: Herein we analyzed improvements obtained on lowering postoperative morbidity on the ground of data derived from a single center surgical population and we draw a learning curve in liver surgery. Methods: From 1989 to 2005, 287 consecutive patients had liver resection for either HCC or liver metastasis. We performed 22 major hepatectomy, 20 left hepatectomy, 14 trisegmentectomy, 77 bisegmentectomy and/or left lobectomy, 74 segmentectomy and 80 wedge resection. Results: In-hospital mortality rate was 4.5%, about 7% in HCC cases and 2.6% in liver metastasis. Morbidity rate was 47.7%. Pringle maneuver length more than 20min (p0.001), the type of liver resection procedure: major hepatectomy (p 0.02) and the request of an amount of blood transfusion over 600 cc (p 0.04) are responsible of the rising of complication, according to the results of multivariate analysis. The learning curve, derived from a logarithmic regression model, showed that we achieved a reduction of development of: pleural effusion (r 0.85), transitory impairment liver function (r 0.81), biliary leakage (r 0.80), liver abscess (r 0.79), and haemoperitoneum (r 0.69). Conclusion: Every liver resection should be plan after intraop- erative ultrasonography, anatomical surgical procedure like segmen- tectomy should be preferred instead of wedge resection; the use of modern devices, like Argon Beam and Ligasure® dissector reduce the incidence of both intraoperative, postoperative bleeding and biliary leakage.