Liver Resections Panco Georgiev, Pierre-Alain Clavien

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Liver Resections

Panco Georgiev, Pierre-Alain Clavien

Indications and Contraindications

Indications

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Primary and secondary malignancy (e.g., hepatocellular carcinoma, intrahepatic cholangiocarcinoma, colorectal metastases, neuroendocrine tumors)

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Benign neoplasia (e.g., adenoma, giant hemangioma)

■

Echinococcus multilocularis (alveolaris)

■

Abscesses refractory to conservative management

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Other benign diseases (e.g., Caroli syndrome)

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Living donor liver transplantation (modiﬁed technique; see chapter “Living Donor Liver Transplantation”)

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Klatskin’s tumor (modiﬁed approach to the bile duct; see Section 4

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Traumatic liver lesions

Contraindications

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Acute hepatitis (viral or alcoholic)

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Severe chronic hepatitis

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Poor liver reserve (e.g., Child-Pugh C cirrhosis)

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Severe portal hypertension (e.g., esophageal varices, ascites or hepatic venous pressure gradient >10mmHg)

■

Severe coagulopathy despite vitamin K administration

■

Severe thrombopenia (platelet count <30,000/mm

³

)

Preoperative Investigation and Preparation for the Procedure

History: Alcohol, hepatitis and hepatotoxic medication, blood transfusions, tattoos, etc.

Clinical evaluation: Encephalopathy, ascites, jaundice, nutritional status, signs of portal hypertension

Laboratory tests: ALT, AST, bilirubin, alkaline phosphatase, albumin, coagulation parameters (PT, platelets), tumor markers and serologies (e.g., hepatitis, echinococcus) when indicated

CT scan or MRI Assessment of liver volume (major resections) and resectability of the lesion

PET scan Searching for extrahepatic lesions (e.g., colorectal metastases)

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Postoperative Tests

■

Postoperative surveillance in an intensive or intermediate care unit

■

Coagulation parameters and hemoglobin for at least 48h

■

Liver Resections Panco Georgiev, Pierre-Alain Clavien

Liver Resections

Panco Georgiev, Pierre-Alain Clavien

Indications and Contraindications

Indications

Primary and secondary malignancy (e.g., hepatocellular carcinoma, intrahepatic cholangiocarcinoma, colorectal metastases, neuroendocrine tumors)

Benign neoplasia (e.g., adenoma, giant hemangioma)

Echinococcus multilocularis (alveolaris)

Abscesses refractory to conservative management

Other benign diseases (e.g., Caroli syndrome)

Living donor liver transplantation (modiﬁed technique; see chapter “Living Donor Liver Transplantation”)

Klatskin’s tumor (modiﬁed approach to the bile duct; see Section 4

Traumatic liver lesions

Contraindications

Acute hepatitis (viral or alcoholic)

Severe chronic hepatitis

Poor liver reserve (e.g., Child-Pugh C cirrhosis)

Severe portal hypertension (e.g., esophageal varices, ascites or hepatic venous pressure gradient >10mmHg)

Severe coagulopathy despite vitamin K administration

Severe thrombopenia (platelet count <30,000/mm

)

Preoperative Investigation and Preparation for the Procedure

History: Alcohol, hepatitis and hepatotoxic medication, blood transfusions, tattoos, etc.

Clinical evaluation: Encephalopathy, ascites, jaundice, nutritional status, signs of portal hypertension

Laboratory tests: ALT, AST, bilirubin, alkaline phosphatase, albumin, coagulation parameters (PT, platelets), tumor markers and serologies (e.g., hepatitis, echinococcus) when indicated

CT scan or MRI Assessment of liver volume (major resections) and resectability of the lesion

PET scan Searching for extrahepatic lesions (e.g., colorectal metastases)

Postoperative Tests

Postoperative surveillance in an intensive or intermediate care unit

Coagulation parameters and hemoglobin for at least 48h

Check daily for clinical signs of liver failure such as jaundice and encephalopathy

Postoperative Complications

Short term:

– Pleural effusion – Ascites

– Liver failure

– Intra-abdominal bleeding – Bile leak

– Subphrenic abscess – Portal vein thrombosis

Long term:

– Biloma

– Biliary stricture – Bronchobiliary ﬁstula