Although much visible Progress has been made in recent years in the filed of liver surgery, there still exixt many unsolved problems, especially, cases of hepatic lobectomy show rather bad results in surgical life span. I wish to review every point of interest with regard to 19 cases of hepatic lobectomy done by us; the summerized results follow:
(1) Among patients admitted to P.N.U.H. between November 1959 and April 1968, 61 cases were admitted with a view to perhaps doing lobectomy. 26 cases were of primary carcinoma thought to bo operable;)4 had left lobectomy and 5 had total right lobectomy and 15 were inoperable). 19 were cases of secondary carcinoma (2 had left hepatic lobectomy, I had total right lobectomy and 2 had partial right lobectomy and 2 had pertial right lobectomy. 14 were inoperable). 15 were cases of hepatic injury, 2 had right partial lobectomy and I had left lobectomy). There was an case of hemangioma of liver ofr whom al right total hepatectomy was done.
(2) Provided the surgeon has the necessary knowledge of intrahepatic anatomy, and adequate evaluation of hepatic function is done. We consider hepatic lobectomy to be as safe a procedure as other intraabdominal surgery
(3) Most cases of hepatic lobectomy were done to hepatic carcinoma of 19 cases of hepatoma, 5 were of secondary hepatic carcinoma, I was due to a hemangioma, and 4 were due ot injury to the liver.
(4) Among the 4 cases receiving left hepatic lobectomy, 2 were for secondary hepatic carcinoma, and I was done for injury to the liver.
Among tthe cases receiving right hepatic lobectomy, 5 were for primary hepatic carcinoma, 1 was done for secondary carcinoma, 2 for liver injury, and one for hemangioma.
Among cases receving right partial hepatic lobectomy, 2 were for secondary hepatic carcinoma, 1 for hepatic injury.
(5) The age of most frequency at which hepatic lobectomy was done in the series was 50 years (9 cases) next was 40years (4 cases). The sex ratio for the series was male: female is 14:5.
(6) 9 cases(47.3%) of primary hepatoma were found to be radically operable and 3 cases(15.7%) of cases with secondary hepatoma were found to be radically operable.
(7) Of the operable cases coming to the hospital within 3 months of the onest of illness, 9(47.3%) had primary hepatoma and 1 (5.7%) had secondary hepatoma. There were 4(21.0%)operable cases come to hospital between 3 and 6 months from the onset of disease.
(8) In the hepatic injury cases, the segmental hepatic resection were possible anatomically and in the hepatoma cases. Operative porcedures were of the quillotine type and controlled type.
(9) The highest incidence of death in all hepatectomies was between the 2nd and 5th month after opration (6 cases, 31.2%). 3 patient (15.6%) died between the 6th and 12th months after operation. 3 cases (21.4%) died 1 year and 2 years after operation. 4 patients (20.8%) having 1 hemangioma in right lobe and 3 having injury to the liver, still alive 2 years after operation.
(10) Complications (52.6%) encountered in this series of hepatic lobectomies, were as follows:
I Case with right liver injury with multiple rib fractures and pleural effusion had insufficiency of lung function. 1 case of primary hepatoma was thought to be have brain metastasis, 2 1/2 months after surgery, 1 case went into hepatic coma 9 days after lobectomy, 4 cases were infected and had poor liver function, and 3 cases with poor liver function had biliary fistula.
(11) Cause of death was as follows
Hepatic coma: 1 case
Liver function insufficiency and biliary fistula: 3 cases
Massive multiple rib fracture and pleural effusion: 1 case
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