Major Hepatectomies: Outcome and Perspectives from Eastern Nepal PC10-PC13
Dr. Narendra Pandit,
Associate Professor, Surgical Gastroenterology Division, Department of Surgery, B P Koirala Institute of Health Sciences,
Dharan-56700, Sunsari, Nepal.
Introduction: Liver resection is a widely used surgical procedure for different benign and malignant pathology, which carries a significant morbidity and mortality (5-10%). Post-hepatectomy liver failure and bile leak are the major complications of major (>3 segments) hepatectomy, and is also the determinant factor for mortality. However, recently due to multimodality development like better surgeons experience, advanced imaging modality and better surgical planning, the outcome has significantly improved. Moreover, with relocation of experienced surgeons, selection of patients and sharing of operative techniques and perioperative care pathways had made possibility of performing major hepatectomy at even low volume academic centre, with almost comparable outcome to high volume centre.
Aim: To study the outcome of major hepatectomy at an academic institute of Nepal, which has a specialised hepatopancreatobiliary unit with its trained surgeon from a high volume centre.
Materials and Methods: Retrospective analysis of all patients undergoing major hepatectomy between December 2015 to July 2017 was done. Patient demographics, clinical characteristics, operative details, morbidity and mortality were recorded.
Results: There were 6 (24%) major hepatectomy, out of 25 liver resection. Five (83.3%) were for malignant pathology: Right hepatectomy-1; Extended right hepatectomy-1; Central hepatectomy-1; Left hepatectomy-3. The mean age of the patient was 50.8 years, with M:F ratio of 1:2. Jaundice was seen in 50% of patients and none required preoperative biliary drainage or portal vein embolisation. The mean operating time, blood loss and transfusion requirement were 216 minutes, 408 mL and one pint respectively. Three (50%) patients developed major bile leak, which was managed conservatively. There was no postoperative, 30-day or 90-day mortality.
Conclusion: Major hepatectomy is a safe and feasible option at our centre despite limited resources and low-volume set-up.