Analysis of factors influencing early outcome following liver resection

Abstract

Introduction The primary aim was to investigate factors associated with post-operative morbidity and mortality following liver resection. A secondary aim was to analyse the outcome of liver resection for colorectal liver metastases (CRLM) to identify factors associated with tumour recurrence and survival.

Methods A retrospective review of a prospectively maintained database of patients undergoing liver resection between 2005 and 2012 was performed.

Results and Conclusions Over a seven-year period 504 liver resections were performed. Liver resection for CRLM was performed less frequently among the most socioeconomically deprived population. However, socioeconomic deprivation was not associated with tumour recurrence (P=0.867). The major complication rate was 18.7% and was significantly associated with age, male gender, insulin-dependent diabetes, hypoalbuminaemia, synchronous bowel procedures, the extent of resection and requirement for blood transfusion. The 90-day mortality rate was 2.7% in patients without post-hepatectomy liver failure or renal dysfunction, 20% in patients with single organ dysfunction and 45% in patients with both. Post-operative serum lactate predicted the 90-day mortality rate (28% when post-operative lactate ≥6mmol/L compared to 0.7% when lactate ≤2mmol/L). In the staging of patients with CRLM, the use of MRI in addition to CT showed no association with lower rates of post-operative intra-hepatic tumour recurrence (P=0.737) or disease-free survival (P=0.487). Recurrence rates were lower in patients when a fibrous tumour pseudocapsule was present (P=0.026). There was no association between tumour doubling time prior to surgery and post-operative survival. Change in tumour size after completion of chemotherapy is variable and sometimes rapid, especially in patients who initially respond to treatment. However, disease-free survival is determined by tumour behaviour during treatment and not by change in size after completion of chemotherapy. Clinicians should consider multimodality imaging preoperatively, evaluate the role of preoperative MRI in the staging of colorectal liver metastases, and not use rate of growth of colorectal liver metastases as a predictor of poor outcome, Postoperative lactate should be used to guide level of postoperative care, and post hepatectomy liver failure in combination with renal dysfunction used to assess clinical progress. Histopathological reporting of the presence of pseudocapsules should be performed.