M Liver resection
Patients presenting for hepatic surgery may have primary or metastatic tumors from gastrointestinal and other sources. Liver function may be entirely normal in these patients. Hepatocellular carcinoma is common in men older than 50 years and is associated with chronic, active hepatitis B and cirrhosis. Although most major liver resections can be performed by a transabdominal approach, some surgeons prefer a thoracoabdominal approach. The liver is transected by blunt dissection using the Cavitron ultrasonic suction aspirator and argon beam laser coagulator. Newer ablation devices include hydro jet and ultrasonic pulses.
As the principles and techniques of hepatic surgery have evolved, the overall mortality and morbidity rates have improved considerably. Because the normal liver can regenerate, it is possible to resect the right or left lobe along with segments of the contralateral lobe. In patients with cirrhosis, the regeneration process is limited; thus, uninvolved liver should be preserved.
The following preoperative considerations are for patients without hepatic cirrhosis:
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