S. C. Pawar1, A. Robinson1, R. S. Chamberlain1 1Saint Barnabas Medical Center,Surgery,Livingston, NJ, USA
Introduction: Anatomic variations and technical nuances involved in performing a left sided hepatic resection versus a right-sided hepatic resection make the procedures distinctly different. This study examined the relationship between laterality and perioperative outcomes in hepatic hemi-resection and aimed to determine whether specific complications are associated with the types of hepatic resection, and if so whether unique complication profiles exist for left and/or right hemiresections.
Methods: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was used to identify patients who underwent elective open hepatectomies between 2002 and 2012. Demographics, 60 perioperative risk factors, and 32 postoperative complications were analysed using Multivariate analyses.
Results: Among 5,355 patients, 2,614 underwent right hepatic resection, 1,439 left hepatic resection, and 1,302 extended hepatic resection. The median age was 60 years; with a male to female ratio of 1:1 and 65 % of patients had an ASA score of 3 to 4. Among patients undergoing open elective hepatectomies 44 % had disseminated cancer and 22 % had received chemotherapy prior to surgery. The most prevalent co-morbidity was hypertension (46%).The three groups were similar with regards to preoperative comorbidities.Overall 30-day mortality rate was 3.3% (173/5,243) and morbidity was 50.5%. The 30 day mortality rate was significantly higher among trisegmentectomy and right hepatectomy patients relative to left hepatectomies (4.8% and 3.6 % Vs 1.5%). Patients with right sided hepatic resections had a higher rate of morbidity in terms of number of cases with 5 or more complications (4.6% vs. 2%; p < 0.001), and overall morbidity (51% vs. 41%, p < 0.001). Though superficial site infection (SSI) rates were similar for both procedures (5% vs. 4.6 %, p < 0.04), right hepatic resections had a higher rate of organ/space SSI (7.3% vs. 6%, p < 0.001). Left sided hepatic resection had lower rates of blood transfusions (28.6% vs. 36%, p < 0.0001); lower respiratory complications (3.5% vs 5%, p < 0.001), lower renal complications (0.8% vs. 1.6%, p < 0.001) and a shorter hospital stay (6 vs 7, p < 0.05).
Conclusion: Analysis of the NSQIP perioperative outcomes data confirms that extended hepatectomies (trisegmentectomy) are associated with the highest risk for mortality and morbidity. Right hepatic lobectomy is associated with a significantly higher incidence of post-operative complications than left hepatic lobectomy, most notably with regards to intraoperative/postoperative blood transfusions, biliary leaks, cardiac complications, sepsis and 30 day operative mortality.
