Major hepatic resection.

Among 75 major hepatic resections from 1968 to 1978, 58 were done for severe, devitalizing hepatic trauma, two thirds of which was blunt trauma. Anatomic lobectomies were done in 32 of the trauma cases. Of the 42 patients who survived, 17 had complications postoperatively. Five patients died intraoperatively of exsanguinating hemorrhage. Eleven additional patients died between days 1 and 42, four of them within two days of cardiovascular collapse. Seventeen major resections for tumor and other conditions carried a 12% mortality; four patients each had one complication postoperatively. These cases were compared with the 50 cases previously reported from this institution, totaling 125 major hepatic resections. Despite increasing severity of injury, mortality in such trauma victims has improved from 33% in the previous series to 28% in this series; it was 24% in the latter half of this series. Mortality for elective resections has improved from 23% in the earlier series to 12% in this series. Postoperative morbidity also was reduced.