Short-term Outcomes Following Open Hepatic Resection: A Single-center Prospective Study in a Low-resource Setting

Abstract

Background: The definitive surgical treatment for several benign and malignant disorders is liver resection. Hepatic resection has evolved from a high-risk procedure to a recognized therapeutic approach with indications spanning from primary hepatobiliary cancer to metastatic illnesses. Objective: To review the early outcomes of hepatic resection Hepatobiliary Surgery unit of Department of Surgery of Dhaka Medical College and Hospital, Dhaka, Bangladesh from January 2023 to January 2024. Methods: This prospective study was conducted in Hepatobiliary Surgery unit of Department of Surgery of Dhaka Medical College and Hospital, Dhaka, Bangladesh from January 2023 to January 2024 which included patients who underwent different types of hepatic resection. We analyzed the pathology, magnitude of hepatic resection and short-term outcomes (90 days) in the patients. Mean and standard deviations were used to describe categorical data whereas frequencies and proportions to describe quantitative data. Univariate analysis and multivariate logistic regression analysis was done to look at the factors associated with morbidity, mortality and blood loss during surgery. A p value less than 0.05 was considered statistically significant. Results: Out of the 25 participants, 20(80.0%) were males and 5(20.0%) were females. The overall mean age was 52±14 years. Besides, 22(88%) patients had American Society of Anaesthesiologist (ASA) score of II).  12(40.0%) underwent hepatic resection for underlying hepatocellular carcinoma (HCC). Also, 7(28.0%) patients underwent hepatic resection for benign conditions and the most common indication was hepatolithiasis. Left lobectomy was most common resection (52.0%). The mean duration of surgery was 180±138 minutes with a mean estimated blood loss (EBL) of 550ml. Surgical complications were noticed in 15(75.0%) of the patients including surgical site infection in 12(48.0%), bile leak in 4(16.0%), intra-abdominal collection in 4(16.0%) and postoperative haemorrhage in 4(16.0%) patients. There was one mortality who suffered from HCC.  Multivariate logistic regression analysis showed advanced age, surgical pathology and ASA grade were independent predictors of overall outcome (p<0.05). Conclusion: Proper pre-operative optimization and appropriate patient selection can provide a better early postoperative outcomes for the patients undergoing liver resections.