Redefining major hepatic resection for colorectal liver metastases: Analysis of 1111 liver resections

• With the evolution of hepatic surgery, the current definition of a major resection namely ≥3 Couinaud segments is now inadequate.
• Morbidity and mortality data indicate that only when ≥5 segments are excised should a liver resection be termed “major”.
• 30 days is inadequate to assess perioperative mortality, and a 90-day follow-up should be adopted to standardise reporting.

IntroductionA major hepatic resection is currently defined as resection of 3 or more segments. The aim of this study was to analyse the post-operative morbidity and mortality of hepatic resections in relation to the number of segments excised.Patients and methodsFrom January 2000 to December 2010, 1111 liver resections were performed for colorectal liver metastases (CRLM). Data were collected from a prospectively maintained database and analysed according to the extent of resection performed.Results457 patients had 1–2, 362 had 3–4 and 292 had 5–6 segments resected respectively. In comparing 1–4 vs. 5–6 segments, overall morbidity (16.7% vs 40.7%; p < 0.001), hepatic failure (0.6% vs 10.6%; p < 0.001); mean hospital stay (8 vs 13.5 days; p = 0.000), mean ICU stay (4.4 vs 6.5 days; p = 0.01), 60-day mortality (0.7% vs 3.4%; p = 0.002), and 90-day mortality (0.7% vs 3.4%; p = 0.002) were significantly different. When analysing the 3–4 vs 5–6 segment resections, morbidity (21.8% vs 40.7%; p < 0.001), hepatic failure (1.4% vs 10.6%; p = 0.000), 60-day mortality (0.7% vs 3.4%; p = 0.002), and 90-days mortality (0.8% vs 3.4%; p = 0.023) remained statistically significant.ConclusionsDifferences in outcome would suggest a revision of the current classification. Only when 5 or more segments are excised for CRLM should a liver resection be considered “major”.