Major liver resection: perioperative course and management

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Major liver resections are complex procedures often necessitated by primary liver cancer or colorectal metastases.
• Perioperative management strategies significantly impact patient outcomes following extensive liver surgery.

Purpose of the Study:

• To investigate the perioperative course of 81 consecutive major liver resections.
• To evaluate the impact of surgical techniques and nutritional support on complications and outcomes.

Main Methods:

• Transabdominal liver resection with or without hilar structure ligation.
• Preoperative intravenous 10% dextrose infusion as the primary nutritional support.
• Analysis of intraoperative blood loss, operative time, and postoperative complications.

Main Results:

• Major complications (bleeding, infection, liver failure) occurred in 12% of patients, primarily after right or extended right lobectomies.
• Higher intraoperative blood loss correlated with increased postoperative complications.
• Direct parenchymal approach reduced operative time without increasing bleeding; preoperative glucose infusion maintained stable blood glucose levels.

Conclusions:

• Prevention of intraoperative bleeding is paramount in major liver resections.
• Preoperative glucose infusion is effective nutritional support, rendering routine administration of other nutrients unnecessary.
• Ligation of hilar structures before resection offers no discernible advantage in managing bleeding.