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      Liver resection: 10-year experience from a single Institution Translated title: Ressecção hepática: experiência de 10 anos de uma única Instituição

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          Abstract

          BACKGROUND: Liver resection constitutes the main treatment of most liver primary neoplasms and selected cases of metastatic tumors. However, this procedure is associated with significant morbidity and mortality rates. AIM: To analyze our experience with liver resections over a period of 10 years to determine the morbidity, mortality and risk factors of hepatectomy. PATIENTS AND METHODS: Retrospective review of medical records of patients who underwent liver resection from January 1994 to March 2003. RESULTS: Eighty-three (41 women and 42 men) patients underwent liver resection during the study period, with a mean age of 52.7 years (range 13-82 years). Metastatic colorectal carcinoma and hepatocellular carcinoma were the main indications for hepatic resection, with 36 and 19 patients, respectively. Extended and major resections were performed in 20.4% and 40.9% of the patients, respectively. Blood transfusion was needed in 38.5% of the operations. Overall morbidity was 44.5%. Life-threatening complications occurred in 22.8% of cases and the most common were pneumonia, hepatic failure, intraabdominal collection and intraabdominal bleeding. Among minor complications (30%), the most common were biliary leakage and pleural effusion. Size of the tumor and blood transfusion were associated with major complications (P = 0.0185 and P = 0.0141, respectively). Operative mortality was 8.4% and risk factors related to mortality were increased age and use of vascular exclusion (P = 0.0395 and P = 0.0404, respectively). Median hospital stay was 6.7 days. CONCLUSION: Liver resections can be performed with low mortality and acceptable morbidity rates. Blood transfusion may be reduced by employing meticulous technique and, whenever indicated, vascular exclusion.

          Translated abstract

          RACIONAL: A ressecção hepática constitui o principal tratamento da maioria das neoplasias primárias do fígado e de casos selecionados de tumores metastáticos. Entretanto, este procedimento está associado a taxas expressivas de morbidade e mortalidade. OBJETIVO: Analisar a experiência com hepatectomia em um período de 10 anos para determinar os fatores de risco, a morbidade e a mortalidade das ressecções hepáticas. PACIENTES E MÉTODOS: Revisão retrospectiva dos prontuários médicos dos pacientes que foram submetidos a hepatectomia no período de janeiro de 1994 a março de 2003. RESULTADOS: Foi realizada hepatectomia em 83 pacientes (41 mulheres e 42 homens) durante o período do estudo. A idade média dos pacientes foi de 52,7 anos, com variação de 13 a 82 anos. As principais indicações de ressecção hepática foram carcinoma do intestino grosso metastático (36 pacientes) e carcinoma hepatocelular (19 pacientes). Hepatectomias ampliadas e maiores foram realizadas em 20,4% e 40,9% dos pacientes, respectivamente. Transfusão sangüínea foi necessária em 38,5% das operações. A morbidade total foi 44,5%. Complicações com risco de vida ocorreram em 22,8% dos casos e as mais comuns foram pneumonia, insuficiência hepática, coleção intra-abdominal e sangramento intra-abdominal. Entre as complicações menores (30%), as mais comuns foram extravasamento biliar e derrame pleural. O tamanho do tumor e transfusão sangüínea foram associadas com complicações maiores (P = 0,0185 e P = 0,0141, respectivamente). A mortalidade operatória foi de 8,4% e os fatores de risco relacionados com a mortalidade foram idade avançada e realização de exclusão vascular (P = 0,0395 e P = 0,0404, respectivamente). O período de internação médio foi de 6,7 dias. CONCLUSÃO: As hepatectomias podem ser realizadas com baixa mortalidade e aceitável morbidade. Transfusão sangüínea pode ser reduzida com o emprego de técnica meticulosa e quando indicada, a exclusão vascular.

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          Most cited references 36

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          NOTES ON THE ARREST OF HEPATIC HEMORRHAGE DUE TO TRAUMA

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            Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases.

            To determine if transfusion affected perioperative and long-term outcome in patients undergoing liver resection for metastatic colorectal cancer. Blood transfusion produces host immunosuppression and has been postulated to result in adverse outcome for patients undergoing surgical resection of malignancies. Blood transfusion records and clinical outcomes for 1,351 patients undergoing liver resection at a tertiary cancer referral center were analyzed. Blood transfusion was associated with adverse outcome after liver resection. The greatest effect was in the perioperative course, where transfusion was an independent predictor of operative mortality, complications, major complications, and length of hospital stay. This effect was dose-related. Patients receiving one or two units or more than two units had an operative mortality of 2.5% and 11.1%, respectively, compared to 1.2% for patients not requiring transfusions. Transfusion was also associated with adverse long-term survival by univariate analysis, but this factor was not significant on multivariate analysis. Even patients receiving only one or two units had a more adverse outcome. Perioperative blood transfusion is a risk factor for poor outcome after liver resection. Blood conservation methods should be used to avoid transfusion, especially in patents currently requiring limited amounts of transfused blood products.
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              Le foie: Etudes anatomiques et chirurgicales

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                ag
                Arquivos de Gastroenterologia
                Arq. Gastroenterol.
                Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE (São Paulo )
                1678-4219
                December 2004
                : 41
                : 4
                : 229-233
                Affiliations
                [1 ] Universidade Federal do Paraná Brazil
                [2 ] Hospital Nossa Senhora das Graças Brazil
                Article
                S0004-28032004000400006
                10.1590/S0004-28032004000400006
                Product
                Product Information: website
                Categories
                GASTROENTEROLOGY & HEPATOLOGY

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