Top

Published in:

01-05-2008 | original article

Operative Mortality After Hepatic Resection: Are Literature-Based Rates Broadly Applicable?

Authors: Bolanle Asiyanbola, David Chang, Ana Luiza Gleisner, Hari Nathan, Michael A. Choti, Richard D. Schulick, Timothy M. Pawlik

Published in: Journal of Gastrointestinal Surgery | Issue 5/2008

Abstract

Introduction

Literature-based data on mortality after hepatectomy may be misleading, as poor outcomes are less likely to be published. The objective of the current study was to compare published vs public, nationally available mortality rates after hepatic resection.

Materials and Methods

A systematic MEDLINE review was conducted to identify reports of hepatectomy outcome between January 1998–December 2004. Data were analyzed to calculate literature-based mortality rate and then compared with population-based mortality rate for hepatectomy using the Nationwide Inpatient Sample (NIS) dataset.

Results

Twenty-three publications fulfilled screening criteria. The studies included 7,073 patients who had undergone hepatic resection (46.1% within USA vs 53.9% outside USA). Most patients were male (58.6%) with median age of 56 years. Indications for hepatic resection included hepatocellular carcinoma (47.7%), metastatic disease (34.3%), or other (18.1%). Cirrhosis was present in 23.2% of patients; 46.9% patients underwent either a hemi-hepatectomy or extended resection. The literature-based mortality rate was 3.6% (US centers only, 2.8%). Analysis of NIS revealed 11,429 hepatectomy cases. After controlling for gender, age, extent of hepatectomy, hepatocellular cancer diagnosis, and presence of cirrhosis, the adjusted NIS-based perioperative mortality rate for hepatectomy was 5.6% (95% CI, 5.0–6.2%). The relative mortality after hepatectomy was 1.6-fold higher based on population-based data compared with reports from the literature (P < 0.05).

Conclusion

Actual population-based mortality rates for major liver resections may be higher than those reported in the literature. Informed consent should reflect actual local and national mortality rates rather than selective reports from the literature.

Pawlik TM, Choti MA. Surgical therapy for colorectal metastases to the liver. J Gastrointest Surg 2007;11:1057–1077.PubMedCrossRef

Ng KK, Vauthey JN, Pawlik TM, Lauwers GY, Regimbeau JM, Belghiti J et al. Is hepatic resection for large or multinodular hepatocellular carcinoma justified? Results from a multi-institutional database. Ann Surg Oncol 2005;12:364–373.PubMedCrossRef

Pawlik TM, Poon RT, Abdalla EK, Ikai I, Nagorney DM, Belghiti J et al. Hepatectomy for hepatocellular carcinoma with major portal or hepatic vein invasion: results of a multicenter study. Surgery 2005;137:403–410.PubMedCrossRef

Hemming AW, Reed AI, Howard RJ, Fujita S, Hochwald SN, Caridi JG et al. Preoperative portal vein embolization for extended hepatectomy. Ann Surg 2003;237:686–691. discussion 691–683).PubMedCrossRef

Elias D, Benizri E, Pocard M, Ducreux M, Boige V, Lasser P. Treatment of synchronous peritoneal carcinomatosis and liver metastases from colorectal cancer. Eur J Surg Oncol 2006;32:632–636.PubMedCrossRef

Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 2004;240:644–657. discussion 657–648).PubMedCrossRef

Elias D, Baton O, Sideris L, Boige V, Malka D, Liberale G et al. Hepatectomy plus intraoperative radiofrequency ablation and chemotherapy to treat technically unresectable multiple colorectal liver metastases. J Surg Oncol 2005;90:36–42.PubMedCrossRef

Takizawa D, Kakizaki S, Sohara N, Sato K, Takagi H, Arai H et al. Hepatocellular carcinoma with portal vein tumor thrombosis: clinical characteristics, prognosis, and patient survival analysis. Dig Dis Sci 2007;52:3290–3295.PubMedCrossRef

Madoff DC, Abdalla EK, Vauthey JN. Portal vein embolization in preparation for major hepatic resection: evolution of a new standard of care. J Vasc Interv Radiol 2005;16:779–790.PubMed

10.

Chik BH, Liu CL, Fan ST, Lo CM, Poon RT, Lam CM et al. Tumor size and operative risks of extended right-sided hepatic resection for hepatocellular carcinoma: implication for preoperative portal vein embolization. Arch Surg 2007;142:63–69. discussion 69).PubMedCrossRef

11.

Abdalla EK, Hicks ME, Vauthey JN. Portal vein embolization: rationale, technique and future prospects. Br J Surg 2001;88:165–175.PubMedCrossRef

12.

Curley SA, Izzo F, Abdalla E, Vauthey JN. Surgical treatment of colorectal cancer metastasis. Cancer Metastasis Rev 2004;23:165–182.PubMedCrossRef

13.

Pawlik TM, Izzo F, Cohen DS, Morris JS, Curley SA. Combined resection and radiofrequency ablation for advanced hepatic malignancies: results in 172 patients. Ann Surg Oncol 2003;10:1059–1069.PubMedCrossRef

14.

Togo S, Nagano Y, Masui H, Tanaka K, Miura Y, Morioka D et al. Two-stage hepatectomy for multiple bilobular liver metastases from colorectal cancer. Hepatogastroenterology 2005;52:913–919.PubMed

15.

Adam R, Laurent A, Azoulay D, Castaing D, Bismuth H. Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg 2000;232:777–785.PubMedCrossRef

16.

Martin R, Paty P, Fong Y, Grace A, Cohen A, DeMatteo R et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg 2003;197:233–241. discussion 241–232).PubMedCrossRef

17.

Elias D, Detroz B, Lasser P, Plaud B, Jerbi G. Is simultaneous hepatectomy and intestinal anastomosis safe? Am J Surg 1995;169:254–260.PubMedCrossRef

18.

Reddy SK, Pawlik TM, Zorzi D, Gleisner AL, Ribero D, Assumpcao L et al. Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol 2007;14:3481–3491.PubMedCrossRef

19.

Elias D, Ouellet JF, Bellon N, Pignon JP, Pocard M, Lasser P. Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases. Br J Surg 2003;90:567–574.PubMedCrossRef

20.

Weitz J, Blumgart LH, Fong Y, Jarnagin WR, D'Angelica M, Harrison LE et al. Partial hepatectomy for metastases from noncolorectal, nonneuroendocrine carcinoma. Ann Surg 2005;241:269–276.PubMedCrossRef

21.

Yamada H, Katoh H, Kondo S, Okushiba S, Morikawa T. Hepatectomy for metastases from non-colorectal and non-neuroendocrine tumor. Anticancer Res 2001;21:4159–4162.PubMed

22.

Vauthey JN, Pawlik TM, Abdalla EK, Arens JF, Nemr RA, Wei SH et al. Is extended hepatectomy for hepatobiliary malignancy justified? Ann Surg 2004;239:722–730. discussion 730–722).PubMedCrossRef

23.

Zhou L, Rui JA, Wang SB, Chen SG, Qu Q, Chi TY et al. Outcomes and prognostic factors of cirrhotic patients with hepatocellular carcinoma after radical major hepatectomy. World J Surg 2007;31:1782–1787.PubMedCrossRef

24.

Virani S, Michaelson JS, Hutter MM, Lancaster RT, Warshaw AL, Henderson WG et al. Morbidity and mortality after liver resection: results of the patient safety in surgery study. J Am Coll Surg 2007;204:1284–1292.PubMedCrossRef

25.

Nagasue N, Yukaya H. Liver resection for hepatocellular carcinoma: results from 150 consecutive patients. Cancer Chemother Pharmacol 1989;23(Suppl):S78–S82.PubMedCrossRef

26.

Fan ST, Lai EC, Lo CM, Ng IO, Wong J. Hospital mortality of major hepatectomy for hepatocellular carcinoma associated with cirrhosis. Arch Surg 1995;130:198–203.PubMed

27.

Thompson HH, Tompkins RK, Longmire WP Jr. Major hepatic resection. A 25-year experience. Ann Surg 1983;197:375–388.PubMedCrossRef

28.

Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 2002;236:397–406. discussion 406–397).PubMedCrossRef

29.

Dickersin K, Min YI. Publication bias: the problem that won't go away. Ann N Y Acad Sci 1993;703:135–146. discussion 146–138).PubMedCrossRef

30.

Dickersin K, Chan S, Chalmers TC, Sacks HS, Smith H Jr. Publication bias and clinical trials. Control Clin Trials 1987;8:343–353.PubMedCrossRef

31.

Kiroff GK. Publication bias in presentations to the Annual Scientific Congress. ANZ J Surg 2001;71:167–171.PubMedCrossRef

32.

Wennberg DE, Lucas FL, Birkmeyer JD, Bredenberg CE, Fisher ES. Variation in carotid endarterectomy mortality in the Medicare population: trial hospitals, volume, and patient characteristics. JAMA 1998;279:1278–1281.PubMedCrossRef

33.

Overview of the NIS. Available at: http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed on September 12, 2007.

34.

Ston ME Jr, Rehman SU, Conaway G, Sardi A. Hepatic resection at a community hospital. J Gastrointest Surg 2000;4:349–353. discussion 353–344).PubMedCrossRef

35.

Helling TS. Ruminations of an ordinary hepatic surgeon: a journey through the pitfalls of major liver resections. J Gastrointest Surg 2002;6:625–629.PubMedCrossRef

36.

Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, Yeung C et al. Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg 1999;229:322–330.PubMedCrossRef

37.

Hanazaki K, Kajikawa S, Shimozawa N, Mihara M, Shimada K, Hiraguri M et al. Survival and recurrence after hepatic resection of 386 consecutive patients with hepatocellular carcinoma. J Am Coll Surg 2000;191:381–388.PubMedCrossRef

38.

Yoon SS, Charny CK, Fong Y, Jarnagin WR, Schwartz LH, Blumgart LH et al. Diagnosis, management, and outcomes of 115 patients with hepatic hemangioma. J Am Coll Surg 2003;197:392–402.PubMedCrossRef

39.

Jacobs M, McDonough J, ReMine SG. Resection of central hepatic malignant lesions. Am Surg 2003;69:186–189. discussion 189–190).PubMed

40.

Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 2003;138:1198–1206. discussion 1206).PubMedCrossRef

41.

Kammula US, Buell JF, Labow DM, Rosen S, Millis JM, Posner MC. Surgical management of benign tumors of the liver. Int J Gastrointest Cancer 2001;30:141–146.PubMedCrossRef

42.

Finch MD, Crosbie JL, Currie E, Garden OJ. An 8-year experience of hepatic resection: indications and outcome. Br J Surg 1998;85:315–319.PubMedCrossRef

43.

Morino M, Morra I, Rosso E, Miglietta C, Garrone C. Laparoscopic vs open hepatic resection: a comparative study. Surg Endosc 2003;17:1914–1918.PubMedCrossRef

44.

Descottes B, Glineur D, Lachachi F, Valleix D, Paineau J, Hamy A et al. Laparoscopic liver resection of benign liver tumors. Surg Endosc 2003;17:23–30.PubMedCrossRef

45.

Yanaga K, Wakasugi K, Matsusaka T, Kume H. Hepatic resection without mortality at a community hospital. Int Surg 2003;88:87–91.PubMed

46.

Capussotti L, Polastri R. Operative risks of major hepatic resections. Hepatogastroenterology 1998;45:184–190.PubMed

47.

Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 2000;191:38–46.PubMedCrossRef

48.

Redaelli CA, Wagner M, Krahenbuhl L, Gloor B, Schilling MK, Dufour JF et al. Liver surgery in the era of tissue-preserving resections: early and late outcome in patients with primary and secondary hepatic tumors. World J Surg 2002;26:1126–1132.PubMedCrossRef

49.

Torzilli G, Makuuchi M, Inoue K, Takayama T, Sakamoto Y, Sugawara Y et al. No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: is there a way? A prospective analysis of our approach. Arch Surg 1999;134:984–992.PubMedCrossRef

50.

Pol B, Campan P, Hardwigsen J, Botti G, Pons J, Le Treut YP. Morbidity of major hepatic resections: a 100-case prospective study. Eur J Surg 1999;165:446–453.PubMedCrossRef

51.

Kanematsu T, Furui J, Yanaga K, Okudaira S, Shimada M, Shirabe K. A 16-year experience in performing hepatic resection in 303 patients with hepatocellular carcinoma: 1985–2000. Surgery 2002;131:S153–S158.PubMedCrossRef

52.

Choti MA, Bowman HM, Pitt HA, Sosa JA, Sitzmann JV, Cameron JL et al. Should hepatic resections be performed at high-volume referral centers? J Gastrointest Surg 1998;2:11–20.PubMedCrossRef

53.

Glasgow RE, Showstack JA, Katz PP, Corvera CU, Warren RS, Mulvihill SJ. The relationship between hospital volume and outcomes of hepatic resection for hepatocellular carcinoma. Arch Surg 1999;134:30–35.PubMedCrossRef

54.

McCall J, Koea J, Gunn K, Rodgers M, Jarvis J. Liver resections in Auckland 1998–2001: mortality, morbidity and blood product use. N Z Med J 2001;114:516–519.PubMed

55.

Dimick JB, Wainess RM, Cowan JA, Upchurch GR Jr, Knol JA, Colletti LM. National trends in the use and outcomes of hepatic resection. J Am Coll Surg 2004;199:31–38.PubMedCrossRef

56.

Dimick JB, Cowan JA Jr, Knol JA, Upchurch GR Jr. Hepatic resection in the United States: indications, outcomes, and hospital procedural volumes from a nationally representative database. Arch Surg 2003;138:185–191.PubMedCrossRef

57.

Moscati R, Jehle D, Ellis D, Fiorello A, Landi M. Positive-outcome bias: comparison of emergency medicine and general medicine literatures. Acad Emerg Med 1994;1:267–271.PubMedCrossRef

58.

Callaham ML, Wears RL, Weber EJ, Barton C, Young G. Positive-outcome bias and other limitations in the outcome of research abstracts submitted to a scientific meeting. JAMA 1998;280:254–257.PubMedCrossRef

59.

Dickersin K, Min YI, Meinert CL. Factors influencing publication of research results. Follow-up of applications submitted to two institutional review boards. JAMA 1992;267:374–378.PubMedCrossRef

60.

Stern JM, Simes RJ. Publication bias: evidence of delayed publication in a cohort study of clinical research projects. BMJ 1997;315:640–645.PubMed

61.

Dickersin K, Min YI. NIH clinical trials and publication bias. Online J Curr Clin Trials 1993;Doc No 50.

62.

Weintraub WH. Are published manuscripts representative of the surgical meeting abstracts? An objective appraisal. J Pediatr Surg 1987;22:11–13.PubMedCrossRef

Title: Operative Mortality After Hepatic Resection: Are Literature-Based Rates Broadly Applicable?
Authors: Bolanle Asiyanbola
David Chang
Ana Luiza Gleisner
Hari Nathan
Michael A. Choti
Richard D. Schulick
Timothy M. Pawlik
Publication date: 01-05-2008
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 5/2008
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-008-0494-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Operative Mortality After Hepatic Resection: Are Literature-Based Rates Broadly Applicable?

Abstract

Introduction

Materials and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2008

Albendazole is Not Effective for Primary Treatment of Hepatic Hydatid Cysts

Inclusion of Tumor Markers Improves the Correlation of the Milan Criteria with Vascular Invasion and Tumor Cell Differentiation in Patients with Hepatocellular Carcinoma Undergoing Liver Resection (#JGSU-D-07–00462)

Surgical Outcomes in Esophageal Cancer Patients with Tumor Recurrence After Curative Esophagectomy

Surgical Outcomes of Laparoscopic Cholecystectomy for Severe Acute Cholecystitis

Local Recurrence after Laparoscopic Resection of T3 Rectal Cancer without Preoperative Chemoradiation and a Risk Group Analysis: An Asian Collaborative Study

Risk Factors of Postoperative Anastomotic Stricture After Excision of Choledochal Cysts with Hepaticojejunostomy