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COMPARISON OF POSTOPERATIVE MORBIDITY AND HEPATECTOMY-SPECIFIC COMPLICATIONS BETWEEN MAJOR AND MINOR LIVER RESECTIONS FOR LIVER METASTASES
Candice Vieira
*, Madeline M. Silva, Chen-Pin Wang, Xuemei Song, Mio Kitano, Colin M. Court, Caitlin A. McIntyre, Alexander A. Parikh
Department of Surgery, UT Health San Antonio, San Antonio, TX
BackgroundLiver resection is associated with long-term survival in select patients with metastatic disease. While formal hepatectomies were traditionally performed, parenchymal-preserving approaches, particularly following neoadjuvant therapy, have increasingly been adopted. These approaches result in fewer complications, including liver insufficiency. However, the impact of multiple minor resections compared to major resections on postoperative outcomes remains unclear. This study aims to compare overall and hepatectomy-specific complications of increasing numbers of partial (minor) resections versus formal (major) resections using a large hospital-based database.
MethodsA retrospective cohort study utilizing NSQIP PUF and hepatectomy-specific modules (2014–2022) identified patients undergoing hepatic resection for liver metastases. Patients were categorized as undergoing major resections (right, left, or extended hepatectomy) or minor resections (all others). Primary outcomes included 30-day combined and hepatectomy-specific complications (e.g., bile leak, liver failure). Multivariate logistic regression was performed to adjust for confounders associated with postoperative complications.
ResultsAmong 18,311 patients, 5,185 underwent major resections, and 13,125 underwent minor resections ranging from one to more than six. Over the study period, the number of patients undergoing major resections remained stable, while minor resections increased significantly (Figure 2). Adjusted analysis revealed that overall complications were significantly lower in patients undergoing up to five minor resections compared to major resections, but complications were similar for those undergoing ?6 minor resections. Minor resections were consistently associated with significantly fewer hepatectomy-specific complications, regardless of the number of resections (Table 1).
ConclusionIn patients undergoing parenchymal-preserving liver resections for metastatic disease, increasing numbers of minor resections are associated with rising overall morbidity, eventually approaching the morbidity of major resections. However, hepatectomy-specific complications remain lower with minor resections. Parenchymal-preserving techniques should therefore be prioritized, even if multiple minor resections are required to achieve liver clearance. Further studies are needed to identify patient subsets in whom major resections may be more appropriate.
Table 1. Adjusted Odds for 30-Day Morbidity and Hepatectomy-Specific Complications: Multivariate regression accounting for demographics, comorbidities, ASA class, neoadjuvant therapy, and surgical factors.
Figure 2. Trends in Minor and Major Resections (2014–2022): The graph illustrates the stable use of major resections and a notable increase in minor resections over time, highlighting a shift toward parenchymal-sparing surgical strategies.
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