Morbidity and mortality associated with liver resections for primary malignancies in children

Abstract

Purpose: Liver resection (LR) is a high-risk procedure with limited data in the pediatric surgical literature regarding short-term outcomes. Our aim was to characterize the patient population and short-term outcomes for children undergoing LR for malignancy.

Methods: We studied 126 inpatient admissions for children ≤20 years of age undergoing LR in 2009 using the Kids' Inpatient Database. Patients had a principal diagnosis of a primary hepatic malignancy and LR listed as one of the first five procedures. Transplantations were excluded. Complications were defined by ICD-9 codes. High-volume centers performed at least 5 LR.

Results: The mean age was 5.83 years. The morbidity and mortality rates were 30.7 and 3.7%, respectively. The most common causes of morbidity were digestive system complications (7.4%), anemia (7.3%), and respiratory complications (3.8%). 43.9% received a blood product transfusion. The average length of stay was 10.04 days. When compared to low-volume centers, high-volume centers increased the likelihood of a complication fourfold (P = 0.011) but had 0% mortality (P = 0.089).

Conclusion: LR remains a procedure fraught with multiple complications and a significant mortality rate. High-volume centers have a fourfold increase in likelihood of complications compared to low-volume centers and may be related to extent of hepatic resection.