Towards Standardization of Liver Resections in India: Five Hundred Consecutive Oncological Liver Resections- Trends, Techniques and Outcomes.

PURPOSE

To study the trends, techniques, outcomes and improvisations of liver resections over the study period.

METHODS

We analysed prospectively maintained database of patients undergoing liver resections for oncological indications at Tata Memorial Centre, Mumbai, India from June 2010 to October 2016.

RESULTS

Five hundred sixteen patients were operated with median age of 55 years and male to female ratio of 1.6:1. Most commonly operated neoplasms were hepatocellular carcinoma (N = 166), cholangiocarcinoma (N = 72) and metastases from colorectal cancer (N = 129). We performed 219 major hepatic resections (≥3 segments) with overall morbidity of 22.9% (N = 118) and mortality of 4.0% (N = 21). Complex hepatectomies were performed in 78 patients. In order to study the time trends, data was divided into pre-liver clinic era and post liver clinic era. Trend analysis showed improvements in complication grade, hospital stay, blood loss, and overall survival status in post liver clinic era. Liver transection in all our patients was carried out without Pringle manoeuvre under normotensive anaesthesia, only 0.7% of our patients had significant transaminitis beyond POD 5.

CONCLUSION

A dedicated multidisciplinary treatment approach along with standardization of liver resections culminates into optimal treatment outcomes.