Thoracotomy in patients with liver cirrhosis

Of 1030 patients requiring thoracotomy over a 7-year period, 11 had cirrhosis of the liver. The disease was severe (Child class C) in four patients, two of whom had recent variceal bleeding. Control patients with normal liver function recovered from post-thoracotomy hepatic disturbance within a week, but the cirrhotic patients required 2-3 weeks to regain baseline function. Although there were no perioperative deaths among the cirrhotic patients, management of significant pleural effusions required diuretics and plasma or albumin supplementation. Presence of cirrhosis, even advanced disease, need not contraindicate thoracotomy with skilled postoperative management, but the poor overall prognosis in Child class C cirrhosis calls for careful assessment of surgical indication.