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Morbidity and Mortality of Hepatectomy for Benign Liver Tumors
Timothy E. Newhook*, Damien J. Lapar, James M. Lindberg, Todd W. Bauer, Reid Adams, Victor M. Zaydfudim
Department of Surgery, University of Virginia, Charlottesville, VA
Objectives: Liver resection remains the primary treatment for patients with hepatic metastases. Some patients with benign liver tumors undergo hepatectomy, due to tumor related subjective symptoms or concern for malignant transformation. Recent studies continue to emphasize the risk of hepatectomy even with modern operative techniques. This analysis aims to compare the morbidity and mortality of hepatic resection between patients with benign liver tumors and those with metastatic disease
Study Design: All patients who underwent partial or anatomic hepatectomy for benign liver tumors and hepatic metastases reported to the National Surgical Quality Improvement Program (NSQIP) between 2005 and 2011 were included in this retrospective cohort study. Pre-operative patient characteristics, intra-operative morbidity, and postoperative morbidity and mortality were compared between the two groups.
Results: A total of 5,542 patients underwent hepatectomy during the study period: 1,164 (21%) for benign and 4,378 (79%) for metastatic disease. Patients with benign liver tumors were younger and predominantly female (p<0.001). In addition, patients with benign liver tumors had lower ASA class and were less likely to have pre-operative comorbidities such as smoking, diabetes, cardiovascular, pulmonary, and hematologic diseases (all p<0.037). 3,420 (62%) patients underwent partial hepatectomy, while 1657 (30%) and 465 (8%) required anatomic lobectomy or trisectionectomy, respectively. Intra- and post-operative complications, including transfusion requirement, pneumonia, myocardial infarction, deep venous thrombosis, and sepsis were more common in patients with hepatic metastases (all p<0.049). However, rates of other major complications including surgical site infections, pulmonary embolism, renal failure, stroke, coma, cardiac arrest, return to operating room, and ventilator dependence did not differ between the two groups (all p≥0.05). 30-day mortality was 1% among patients with benign liver tumors and 3.2% among patients with hepatic metastases (p=0.128).
Conclusions: Peri-operative mortality for patients with benign liver tumors is 1%. Despite patients with benign disease being younger and healthier, the risk of many major complications is similar between patients undergoing hepatectomy for benign and malignant disease. These findings reinforce avoiding hepatectomy in patients with benign disease in the absence of a clear indication for resection. A careful and balanced risk and benefit discussion should precede hepatic resection in these patients.
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