Reporting outcome of one hundred major liver resections performed by single unit of university teaching hospital: a retrospective cross-sectional study

Background: Major liver resection, defined as the removal of three or more Couinaud segments, remains a complex surgical procedure despite advancements in surgical techniques and perioperative care. This study evaluates the outcomes of the first 100 major liver resections performed by a single Hepato-Pancreato-Biliary (HPB) unit in a university teaching hospital over 11 years. Materials and Methods: A retrospective cross-sectional study was conducted on consecutive patients undergoing major liver resection between October 2012 and July 2023. Patient demographics, surgical techniques, perioperative factors, and postoperative outcomes were analyzed. Statistical evaluation was performed using SPSS version 26. Results: Among 100 major liver resections, the mean patient age was 48 years. Malignancies (60%), particularly hepatocellular carcinoma (19%), were the most common indications, while hemangioma (12%) was the most frequent benign indication. The harmonic scalpel (50%) was the primary parenchymal transection method, and Pringle’s maneuver was applied in 71% of patients. The overall morbidity rate was 52%, with major complications (Clavien-Dindo >2) occurring in 32% of patients. Liver-specific complications included bile leaks (15%), postoperative hemorrhage (3%), and posthepatectomy liver failure (9%, Grade B/C). The overall mortality rate was 3%. Conclusion: This study demonstrates that major liver resections can be performed with acceptable morbidity and low mortality in a developing HPB unit, provided that perioperative management is optimized through a multidisciplinary approach. The complication rates align with outcomes from high-volume centers, emphasizing the importance of meticulous surgical technique, intraoperative blood loss control, and perioperative optimization. Future research should refine patient selection criteria, improve surgical techniques, and integrate minimally invasive approaches to enhance outcomes further.