Hepatic Resection at a Major Community-Based Teaching Hospital Can Result in Good Outcome

Excerpt

We read with interest the article by Metreveli et al.1 Numerous studies have documented that high-volume hospitals achieve lower operative mortality with selected high-risk procedures.2 On the basis of the number of liver resections per year, hospitals were arbitrarily classified as high-volume providers for >15 per year, medium volume for 7 to 15 per year, and low volume for <7 per year.3 The authors suggest that liver resections can be performed safely with low rates of morbidity and operative mortality with careful selection of patients at low- or medium-volume community hospitals. Recent data from our hospital demonstrate the same results.4 During the last 3 years (2002–2004), 22 liver resections performed in our hospital by the same surgeon(s). The causes of liver resection were 13 malignancies (primary or metastatic), 2 traumatic causes, 6 parasitic cysts, and 1 giant hemangioma. The types of liver resections were lobectomy (n = 3), trisegmentectomy (n = 2), segmentectomy (n = 10), and wedge resection (n = 7). The overall mortality rate was 0%, and the overall morbidity rate was 40%. Estimated blood loss ranged from 250 to 1800 mL, with a mean of 370 mL. Eight patients (36.4%) required blood transfusions. In two patients (9%), there was major complication that demanded reoperation and prolonged hospital stay: an anastomotic leak from a hepatojejunal anastomosis and a large biloma from the main biliary duct after a left extensive hepatectomy.4 …