Patterns of Recovery and Clinical Outcomes Following Hepatic Resection: The PKLI Experience

Abstract

Objective: To analyze the correlation between the type of hepatic resection and postoperative recovery parameters in a cohort of 545 patients at the Pakistan Kidney and Liver Institute (PKLI), Lahore.

Methods: This retrospective study reviewed records of patients undergoing liver resection from January 2020 to December 2023. Procedures were categorized into: Right Hepatectomy (RH), Right Extended Hepatectomy (REH), Left Hepatectomy (LH), Left Extended Hepatectomy (LEH), Non-anatomical Resections (NAR), Donor Hepatectomy (DH), Left Lateral Sectionectomy (LLS), Posterior Segmentectomy (PS), and Central Hepatectomy (CH). Recovery was assessed via serial measurements of Haemoglobin (Hb), Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), International Normalized Ratio (INR), incidence of ascites, time to drain removal, wound infection rate, and time to return to work.

Results: Among 545 resections, the most common procedure was NAR (28.1%), followed by DH (22.6%). Major resections (REH, RH) showed the most significant early postoperative perturbations in ALT, AST, and INR (p<0.05). Ascites was most prevalent after REH (18.3%). Donor hepatectomies and minor resections (LLS, NAR) demonstrated the fastest recovery in biochemical parameters, earliest drain removal (mean 5.2 days), and shortest time to return to work (mean 6.1 weeks). Wound infection rates were highest in major resections and correlated with longer operative times.

Conclusion: The extent and complexity of liver resection directly correlate with the tempo and quality of postoperative recovery. Minor and donor resections have a predictably swift recovery, while extended hepatectomies require prolonged and meticulous management. These findings provide a recovery benchmark for a national center in Pakistan.