Personal experience of the author with seventeen cases of major hepatic resection was reviewed. 1. Original diseases for which such resection was undertaken varied; hepatoma (7), choiar-gicma (2), embryonal cellica (2), bile duct cystadenoma (1), gall bladder ca (1), actinomycosis (1), trauma (1), intrahepatic stones (2).
2. All of the mortality (5 cases, 29.5%) occurred during first 9 cases of the experiences and none thereafter. With accumulating experiences, improved technique and better case selection, the operation is rapidly becoming a safe procedure.
3. Hepatic functional derangement during immediate postoperative period follows much the similar pattern; The most striking of which is the decline in serum albumin level sometimes as low as 1gm% after 85% resection rothrombine and other clotting factors also declined regularly, but not enough to cause clinical -con6ern.
Transaminase and bilirabin value increased. The former was more .obvious after left hepate-ctonies and appeared to be related to the amount of devitalized lived tissue left behind. Hype-rbilirubinemia was quite independent from any obstructive mechanism.
All derangement, however, returned to normal between 5th and 15th postoperative day unless major complication scoured.
4. Hepatic regeneration occurred with remarkable rapidity and completeness as recorded by serial external hapatic scintiscanning and in one instance via a second look operation. The stimuli to regenerate semi to parallel the amount of liver tissue removed, and in the case of 85%o resection in an infant, complete regeneration was documented at second operation on the 48th post operative day. Various other factors seem to influence the speed of such regeneration.
Cirrhotic liver also regenerated following major resection though at slower tempo. Interesting observation was that the regenerated liver showed remarkably different histological findings.
5. All cases of benign disease are living and well.
There are two cases of long term survivors who underwent right hepatic lobectomies for cancer. One is a 9 month old infant with embryonal cell type hepatoma who is well after 11 years and the other is a 58 year old woman who underwent right lobectomy for hepatocellular carcinoma 8 years previously. All the recurrences were before 1 year following surgery thus emphasizing the importance of surviving 1 year without evidence of recurrence in predicting long-term prognosis.
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