Liver Resection: Preoperative and Postoperative Care

Stone, Michael D.; Benotti, Peter N.

doi:10.1016/s0039-6109(16)44793-6

Cited by 27 publications

(6 citation statements)

References 55 publications

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“…Previous studies have shown that massive transfusion [7,10,14], underlying hepatic disease [15,16], and the extent of hepatic resection [4,5,7,10,11,15,16] contribute to the development of coagulopathy. The duration of vascular occlusion used to limit blood loss during parenchymal dissection (either via Pringle's maneuver or total hepatic vascular exclusion) also has been suggested as a contributing factor to postoperative coaguloapathy [4,14]. We found that the duration of vascular occlusion was associated with a trend towards an abnormal early postoperative coagulation profile, and it was significantly associated with an abnormal late postoperative coagulation profile.…”

Section: Discussionmentioning

confidence: 99%

Abnormal coagulation profile after hepatic resection: the effect of chronic hepatic disease and implications for epidural analgesia

Yuan

et al. 2012

Journal of Clinical Anesthesia

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Section: Discussionmentioning

confidence: 99%

Abnormal coagulation profile after hepatic resection: the effect of chronic hepatic disease and implications for epidural analgesia

Yuan

et al. 2012

Journal of Clinical Anesthesia

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“…The majority of the postoperative deaths in the cirrhotic patients are caused by liver failure and sepsis. The perioperative factors considered most important for the development of liver failure are blood loss of more than 1500 ml and postoperative infection of any type 20,84,88…”

Section: Results Of Liver Resection For Hcc In Various Series (See Tamentioning

confidence: 99%

“…The perioperative factors considered most important for the development of liver failure are blood loss of more than 1500 ml and postoperative infection of any type. 20,84,88 Long-term survival in Western series of HCC patients ranges between 24% and 51% (3-year) and between 27% and 49% (5-year). In oriental series, the 5-year survival rates range between 11% and 46%.…”

Section: Postoperative Managementmentioning

confidence: 99%

Current status of surgery and transplantation in the management of hepatocellular carcinoma: an overview

Pal

Pande

2001

Journal of Hepato-Biliary-Pancreatic Surgery

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Despite many therapeutic advances in the field of hepatocellular carcinoma over the past two decades, this disease continues to be a major cause of cancer-related mortality worldwide. This review focuses on the recent advances in surgical technique, perioperative management, and transplantation of cirrhotic and noncirrhotic patients with hepatocellular carcinoma. Liver resection continues to be the mainstay of curative treatment in noncirrhotic patients and selected cirrhotic patients with small tumors and preserved liver function. Transplantation should be advocated for patients with poor liver function and localized lesions or for patients with large fibrolamellar carcinomas that are otherwise unresectable. Surgery has a definite role in the management of hepatic recurrences in the absence of systemic dissemination. Newer advances in the therapeutic armamentarium, such as cryotherapy, radiofrequency ablation, microwave coagulation, and ethanol injections are discussed, and their overall efficacy assessed.

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“…The duration of vascular occlusion used to limit blood loss during parenchymal dissection also has been suggested as a contributing factor to post-operative coagulopathy. [ 9 ] In the present study, vascular occlusion techniques were not used. In our centre, cavitron ultrasonic surgical aspirator is used for parenchymal resection as it is associated with low blood loss, a better safety record, with low risk of bile leak.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of post-operative coagulopathy after major hepatic resection at a tertiary care centre in Northern India

et al. 2017

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Background and Aims:Hepatic resection is a major surgery associated with intraoperative massive fluid shifts, blood loss, haemodynamic instability and risk of development of post-hepatectomy liver failure. Hepatic resection predisposes the patient to coagulopathy as well as venous thrombosis. However, due to the development of deranged coagulation profile post-operatively, there is a dilemma in starting thromboprophylaxis. Our aim in this study was to determine the incidence of coagulopathy in patients undergoing major hepatectomy.Methods:In this retrospective study, we included 86 patients who had undergone major hepatectomy between January 2010 and December 2015 at our centre. Intraoperatively, we noted the number of liver segments resected, details of epidural catheter insertion, estimated blood loss, transfusion requirement and need for mechanical ventilation post-operatively. Trends of international normalised ratio (INR) and platelet values were recorded until post-operative day 5.Results:Of the 86 patients, 6 (7%) had an abnormal coagulation profile pre-operatively and 39 (45.34%) patients developed a derangement in their coagulation profile on 1st post-operative day (POD). Platelet count was significantly lower and INR values were significantly higher than the pre-operative values on all 5 PODs. Sixty-seven (78%) patients had pre-operative epidural catheter insertion for post-operative pain management. Mechanical thrombophylaxis was used routinely.Conclusions:The incidence of post-operative coagulopathy in our patients who underwent major liver resection was 45.34%. Epidural catheters could be removed safely without transfusion between POD 5 and 7. There was no incidence of venous thrombosis or thromboembolism.

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Liver Resection: Preoperative and Postoperative Care

Cited by 27 publications

References 55 publications

Abnormal coagulation profile after hepatic resection: the effect of chronic hepatic disease and implications for epidural analgesia

Abnormal coagulation profile after hepatic resection: the effect of chronic hepatic disease and implications for epidural analgesia

Current status of surgery and transplantation in the management of hepatocellular carcinoma: an overview

Retrospective analysis of post-operative coagulopathy after major hepatic resection at a tertiary care centre in Northern India

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