Initial Experience with Major Liver Resection in a Nigerian Tertiary Health Facility

Abstract

Purpose: Liver resection remain the primary treatment of choice for most liver primary neoplasms and selected cases of metastatic tumors. However, this procedure is rarely performed in Nigeria because of the associated with significant morbidity and mortality rates and. The study was aimed at analysing our initial experience with liver resections over a period of 5 years. Methods: Consecutive patients who underwent liver resection from January 2015 to December 2020. Major liver resection was defined as removal of 2 or more liver segment. Results: Eighteen (15 females and 3 males) patients underwent major liver resection during the study period, with a mean age of 53.5 years (range 7- 80 years). The indication for liver resection includes hepatocellular carcinoma in 6 patients, gallbladder cancer in 8 patients, metastatic colorectal carcinoma in 2 and, neuroendocrine tumor in 1 and complex biliary injury in 1. All the patients that had HCC had the tumor on the right lobe of the liver and they had right hepatectomy. Blood transfusion was needed in 3 patients – one patient with rupture hepatocellular carcinoma, a child with hepatoblastoma and a patient with gallbladder cancer. The patient with rupture hepatocellular carcinoma had acute renal insufficiency perioperatively. We recorded 2 (11.1%) operative mortalities. Size of the tumor removed ranged from 4cm to 15cm. Low central venous pressure was achieved in 10 patients and was associated with significantly less blood loss. Vascular exclusion was utilized in 6 cases. Median hospital stay was 7.5 days (range 3-24 days). Conclusion: Liver resections can be performed with low mortality and acceptable morbidity rates in a low resource setting like ours in well selected cases. Blood transfusion may be reduced by employing meticulous technique and, whenever indicated, vascular exclusion.