To evaluate the rationality of resection of ≥4 segments defined as extensive hepatectomy.

Clinical data of 1 441 patients who underwent liver resection of ≥3 segments in Eastern Hepatobiliary Surgery Hospital affiliated to Naval Medical University from January 2000 to December 2016 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 939 patients were male and 502 female, aged from 44 to 60 years, with a median age of 52 years. According to different definitions of extensive hepatectomy, all patients were divided into <4 and ≥4 liver segment resection groups. Specific composite endpoints including liver failure, massive ascites, bile leakage, intra-abdominal hemorrhage and intra-abdominal infection were regarded as the main evaluation parameters. The risk of surgical complications was compared between the ≥4 and <4 liver segment resection groups. Secondary evaluation parameters, such as massive pleural effusion and death, were analyzed. The influencing factors were identified by Logistic regression model.

The incidence of postoperative liver failure, massive ascites, bile leakage, abdominal hemorrhage, abdominal infection, massive pleural effusion and perioperative mortality rate were 58.2%(839/1 441), 9.7%(140/1 441), 11.2%(161/1 441), 10.8%(155/1 441), 4.2%(60/1 441), 5.6%(80/1 441) and 1.3%(19/1 441), respectively. Multivariate Logistic regression analysis showed that the incidence of postoperative liver failure, massive ascites, bile leakage, abdominal infection and massive pleural effusion in ≥4 liver segment resection group was significantly higher than those in the <4 liver segment resection group (OR=3.943, 8.619, 13.184, 1.017, 1.060; P<0.05).

Taking the specific composite endpoints of liver surgery as the main evaluation parameters, it is more rational to define resection of ≥4 liver segments as massive hepatectomy.