[Perioperative management for patients with chronic liver injury and the strategy for preventing postoperative liver...

In liver surgery, postoperative liver failure has been a serious problem of concern. Recently, the advances in the imaging diagnosis and in the operative procedures have contributed to reduce the operative mortality to less than 1%. Between October 1994 and December 1996, a total of 159 patients, including 39 with chronic hepatitis and 66 with cirrhosis, underwent liver resection for hepatocellular carcinomas (n = 103), metastatic tumors (n = 24) and others (n = 32). Although about 20% of patients had some postoperative complications, no patient died of postoperative liver failure. Preoperatively, the liver function was estimated by ICG R15 and CT volume metry, and portal vein embolization and the splenectomy, if necessary, was performed. Blood loss was replaced by plasma as far as possible. Postoperatively, it is most important to maintain the optimal water balance and electrolyte levels using fresh plasma and diuretics. Even in patients with cirrhosis, no operative mortality can be achieved with optimal hepatectomy and careful perioperative management.