Abstract
Introduction
Literature-based data on mortality after hepatectomy may be misleading, as poor outcomes are less likely to be published. The objective of the current study was to compare published vs public, nationally available mortality rates after hepatic resection.
Materials and Methods
A systematic MEDLINE review was conducted to identify reports of hepatectomy outcome between January 1998–December 2004. Data were analyzed to calculate literature-based mortality rate and then compared with population-based mortality rate for hepatectomy using the Nationwide Inpatient Sample (NIS) dataset.
Results
Twenty-three publications fulfilled screening criteria. The studies included 7,073 patients who had undergone hepatic resection (46.1% within USA vs 53.9% outside USA). Most patients were male (58.6%) with median age of 56 years. Indications for hepatic resection included hepatocellular carcinoma (47.7%), metastatic disease (34.3%), or other (18.1%). Cirrhosis was present in 23.2% of patients; 46.9% patients underwent either a hemi-hepatectomy or extended resection. The literature-based mortality rate was 3.6% (US centers only, 2.8%). Analysis of NIS revealed 11,429 hepatectomy cases. After controlling for gender, age, extent of hepatectomy, hepatocellular cancer diagnosis, and presence of cirrhosis, the adjusted NIS-based perioperative mortality rate for hepatectomy was 5.6% (95% CI, 5.0–6.2%). The relative mortality after hepatectomy was 1.6-fold higher based on population-based data compared with reports from the literature (P < 0.05).
Conclusion
Actual population-based mortality rates for major liver resections may be higher than those reported in the literature. Informed consent should reflect actual local and national mortality rates rather than selective reports from the literature.
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References
Pawlik TM, Choti MA. Surgical therapy for colorectal metastases to the liver. J Gastrointest Surg 2007;11:1057–1077.
Ng KK, Vauthey JN, Pawlik TM, Lauwers GY, Regimbeau JM, Belghiti J et al. Is hepatic resection for large or multinodular hepatocellular carcinoma justified? Results from a multi-institutional database. Ann Surg Oncol 2005;12:364–373.
Pawlik TM, Poon RT, Abdalla EK, Ikai I, Nagorney DM, Belghiti J et al. Hepatectomy for hepatocellular carcinoma with major portal or hepatic vein invasion: results of a multicenter study. Surgery 2005;137:403–410.
Hemming AW, Reed AI, Howard RJ, Fujita S, Hochwald SN, Caridi JG et al. Preoperative portal vein embolization for extended hepatectomy. Ann Surg 2003;237:686–691. discussion 691–683).
Elias D, Benizri E, Pocard M, Ducreux M, Boige V, Lasser P. Treatment of synchronous peritoneal carcinomatosis and liver metastases from colorectal cancer. Eur J Surg Oncol 2006;32:632–636.
Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 2004;240:644–657. discussion 657–648).
Elias D, Baton O, Sideris L, Boige V, Malka D, Liberale G et al. Hepatectomy plus intraoperative radiofrequency ablation and chemotherapy to treat technically unresectable multiple colorectal liver metastases. J Surg Oncol 2005;90:36–42.
Takizawa D, Kakizaki S, Sohara N, Sato K, Takagi H, Arai H et al. Hepatocellular carcinoma with portal vein tumor thrombosis: clinical characteristics, prognosis, and patient survival analysis. Dig Dis Sci 2007;52:3290–3295.
Madoff DC, Abdalla EK, Vauthey JN. Portal vein embolization in preparation for major hepatic resection: evolution of a new standard of care. J Vasc Interv Radiol 2005;16:779–790.
Chik BH, Liu CL, Fan ST, Lo CM, Poon RT, Lam CM et al. Tumor size and operative risks of extended right-sided hepatic resection for hepatocellular carcinoma: implication for preoperative portal vein embolization. Arch Surg 2007;142:63–69. discussion 69).
Abdalla EK, Hicks ME, Vauthey JN. Portal vein embolization: rationale, technique and future prospects. Br J Surg 2001;88:165–175.
Curley SA, Izzo F, Abdalla E, Vauthey JN. Surgical treatment of colorectal cancer metastasis. Cancer Metastasis Rev 2004;23:165–182.
Pawlik TM, Izzo F, Cohen DS, Morris JS, Curley SA. Combined resection and radiofrequency ablation for advanced hepatic malignancies: results in 172 patients. Ann Surg Oncol 2003;10:1059–1069.
Togo S, Nagano Y, Masui H, Tanaka K, Miura Y, Morioka D et al. Two-stage hepatectomy for multiple bilobular liver metastases from colorectal cancer. Hepatogastroenterology 2005;52:913–919.
Adam R, Laurent A, Azoulay D, Castaing D, Bismuth H. Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg 2000;232:777–785.
Martin R, Paty P, Fong Y, Grace A, Cohen A, DeMatteo R et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg 2003;197:233–241. discussion 241–232).
Elias D, Detroz B, Lasser P, Plaud B, Jerbi G. Is simultaneous hepatectomy and intestinal anastomosis safe? Am J Surg 1995;169:254–260.
Reddy SK, Pawlik TM, Zorzi D, Gleisner AL, Ribero D, Assumpcao L et al. Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol 2007;14:3481–3491.
Elias D, Ouellet JF, Bellon N, Pignon JP, Pocard M, Lasser P. Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases. Br J Surg 2003;90:567–574.
Weitz J, Blumgart LH, Fong Y, Jarnagin WR, D'Angelica M, Harrison LE et al. Partial hepatectomy for metastases from noncolorectal, nonneuroendocrine carcinoma. Ann Surg 2005;241:269–276.
Yamada H, Katoh H, Kondo S, Okushiba S, Morikawa T. Hepatectomy for metastases from non-colorectal and non-neuroendocrine tumor. Anticancer Res 2001;21:4159–4162.
Vauthey JN, Pawlik TM, Abdalla EK, Arens JF, Nemr RA, Wei SH et al. Is extended hepatectomy for hepatobiliary malignancy justified? Ann Surg 2004;239:722–730. discussion 730–722).
Zhou L, Rui JA, Wang SB, Chen SG, Qu Q, Chi TY et al. Outcomes and prognostic factors of cirrhotic patients with hepatocellular carcinoma after radical major hepatectomy. World J Surg 2007;31:1782–1787.
Virani S, Michaelson JS, Hutter MM, Lancaster RT, Warshaw AL, Henderson WG et al. Morbidity and mortality after liver resection: results of the patient safety in surgery study. J Am Coll Surg 2007;204:1284–1292.
Nagasue N, Yukaya H. Liver resection for hepatocellular carcinoma: results from 150 consecutive patients. Cancer Chemother Pharmacol 1989;23(Suppl):S78–S82.
Fan ST, Lai EC, Lo CM, Ng IO, Wong J. Hospital mortality of major hepatectomy for hepatocellular carcinoma associated with cirrhosis. Arch Surg 1995;130:198–203.
Thompson HH, Tompkins RK, Longmire WP Jr. Major hepatic resection. A 25-year experience. Ann Surg 1983;197:375–388.
Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 2002;236:397–406. discussion 406–397).
Dickersin K, Min YI. Publication bias: the problem that won't go away. Ann N Y Acad Sci 1993;703:135–146. discussion 146–138).
Dickersin K, Chan S, Chalmers TC, Sacks HS, Smith H Jr. Publication bias and clinical trials. Control Clin Trials 1987;8:343–353.
Kiroff GK. Publication bias in presentations to the Annual Scientific Congress. ANZ J Surg 2001;71:167–171.
Wennberg DE, Lucas FL, Birkmeyer JD, Bredenberg CE, Fisher ES. Variation in carotid endarterectomy mortality in the Medicare population: trial hospitals, volume, and patient characteristics. JAMA 1998;279:1278–1281.
Overview of the NIS. Available at: http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed on September 12, 2007.
Ston ME Jr, Rehman SU, Conaway G, Sardi A. Hepatic resection at a community hospital. J Gastrointest Surg 2000;4:349–353. discussion 353–344).
Helling TS. Ruminations of an ordinary hepatic surgeon: a journey through the pitfalls of major liver resections. J Gastrointest Surg 2002;6:625–629.
Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, Yeung C et al. Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg 1999;229:322–330.
Hanazaki K, Kajikawa S, Shimozawa N, Mihara M, Shimada K, Hiraguri M et al. Survival and recurrence after hepatic resection of 386 consecutive patients with hepatocellular carcinoma. J Am Coll Surg 2000;191:381–388.
Yoon SS, Charny CK, Fong Y, Jarnagin WR, Schwartz LH, Blumgart LH et al. Diagnosis, management, and outcomes of 115 patients with hepatic hemangioma. J Am Coll Surg 2003;197:392–402.
Jacobs M, McDonough J, ReMine SG. Resection of central hepatic malignant lesions. Am Surg 2003;69:186–189. discussion 189–190).
Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 2003;138:1198–1206. discussion 1206).
Kammula US, Buell JF, Labow DM, Rosen S, Millis JM, Posner MC. Surgical management of benign tumors of the liver. Int J Gastrointest Cancer 2001;30:141–146.
Finch MD, Crosbie JL, Currie E, Garden OJ. An 8-year experience of hepatic resection: indications and outcome. Br J Surg 1998;85:315–319.
Morino M, Morra I, Rosso E, Miglietta C, Garrone C. Laparoscopic vs open hepatic resection: a comparative study. Surg Endosc 2003;17:1914–1918.
Descottes B, Glineur D, Lachachi F, Valleix D, Paineau J, Hamy A et al. Laparoscopic liver resection of benign liver tumors. Surg Endosc 2003;17:23–30.
Yanaga K, Wakasugi K, Matsusaka T, Kume H. Hepatic resection without mortality at a community hospital. Int Surg 2003;88:87–91.
Capussotti L, Polastri R. Operative risks of major hepatic resections. Hepatogastroenterology 1998;45:184–190.
Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 2000;191:38–46.
Redaelli CA, Wagner M, Krahenbuhl L, Gloor B, Schilling MK, Dufour JF et al. Liver surgery in the era of tissue-preserving resections: early and late outcome in patients with primary and secondary hepatic tumors. World J Surg 2002;26:1126–1132.
Torzilli G, Makuuchi M, Inoue K, Takayama T, Sakamoto Y, Sugawara Y et al. No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: is there a way? A prospective analysis of our approach. Arch Surg 1999;134:984–992.
Pol B, Campan P, Hardwigsen J, Botti G, Pons J, Le Treut YP. Morbidity of major hepatic resections: a 100-case prospective study. Eur J Surg 1999;165:446–453.
Kanematsu T, Furui J, Yanaga K, Okudaira S, Shimada M, Shirabe K. A 16-year experience in performing hepatic resection in 303 patients with hepatocellular carcinoma: 1985–2000. Surgery 2002;131:S153–S158.
Choti MA, Bowman HM, Pitt HA, Sosa JA, Sitzmann JV, Cameron JL et al. Should hepatic resections be performed at high-volume referral centers? J Gastrointest Surg 1998;2:11–20.
Glasgow RE, Showstack JA, Katz PP, Corvera CU, Warren RS, Mulvihill SJ. The relationship between hospital volume and outcomes of hepatic resection for hepatocellular carcinoma. Arch Surg 1999;134:30–35.
McCall J, Koea J, Gunn K, Rodgers M, Jarvis J. Liver resections in Auckland 1998–2001: mortality, morbidity and blood product use. N Z Med J 2001;114:516–519.
Dimick JB, Wainess RM, Cowan JA, Upchurch GR Jr, Knol JA, Colletti LM. National trends in the use and outcomes of hepatic resection. J Am Coll Surg 2004;199:31–38.
Dimick JB, Cowan JA Jr, Knol JA, Upchurch GR Jr. Hepatic resection in the United States: indications, outcomes, and hospital procedural volumes from a nationally representative database. Arch Surg 2003;138:185–191.
Moscati R, Jehle D, Ellis D, Fiorello A, Landi M. Positive-outcome bias: comparison of emergency medicine and general medicine literatures. Acad Emerg Med 1994;1:267–271.
Callaham ML, Wears RL, Weber EJ, Barton C, Young G. Positive-outcome bias and other limitations in the outcome of research abstracts submitted to a scientific meeting. JAMA 1998;280:254–257.
Dickersin K, Min YI, Meinert CL. Factors influencing publication of research results. Follow-up of applications submitted to two institutional review boards. JAMA 1992;267:374–378.
Stern JM, Simes RJ. Publication bias: evidence of delayed publication in a cohort study of clinical research projects. BMJ 1997;315:640–645.
Dickersin K, Min YI. NIH clinical trials and publication bias. Online J Curr Clin Trials 1993;Doc No 50.
Weintraub WH. Are published manuscripts representative of the surgical meeting abstracts? An objective appraisal. J Pediatr Surg 1987;22:11–13.
Acknowledgments
Dr. Pawlik and Dr. Nathan are supported by Grant Number 1KL2RR025006-01from National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.
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Asiyanbola, B., Chang, D., Gleisner, A.L. et al. Operative Mortality After Hepatic Resection: Are Literature-Based Rates Broadly Applicable?. J Gastrointest Surg 12, 842–851 (2008). https://doi.org/10.1007/s11605-008-0494-y
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DOI: https://doi.org/10.1007/s11605-008-0494-y