Perioperative Management of Complex Hepatectomy for Colorectal Liver Metastases: The Alliance Between the Surgeon and the Anesthetist

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2021 Jun 2

PMID 34063684

Citations 5

Authors

Enrico Giustiniano

Fulvio Nisi

Laura Rocchi

Paola C Zito

Nadia Ruggieri

Matteo M Cimino

Guido Torzilli

Maurizio Cecconi

Affiliations

Soon will be listed here.

Abstract

Hepatic resection has been widely accepted as the first choice for the treatment of colorectal metastases. Liver surgery has been recognized as a major abdominal procedure; it exposes patients to a high risk of perioperative adverse events. Decision sharing and the multimodal approach to the patients' management are the two key items for a safe outcome, even in such a high-risk surgery. This review aims at addressing the main perioperative issues (preoperative evaluation; general anesthesia and intraoperative fluid management and hemodynamic monitoring; intraoperative metabolism; administration policy for blood-derivative products; postoperative pain control; postoperative complications), in particular, from the anesthetist's point of view; however, only an alliance with the surgery team may be successful in case of adverse events to accomplish a good final outcome.

Citing Articles

Liver Resection for Hepatocellular Carcinoma: Recent Advances.

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Major liver resections, perioperative issues and posthepatectomy liver failure: A comprehensive update for the anesthesiologist.

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High Arterial Lactate Levels after Hepatic Resection Are Associated with Low Oxygen Delivery and Predict Severe Postoperative Complications.

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References

Yamazaki S, Takayama T, Moriguchi M, Mitsuka Y, Okada S, Midorikawa Y . Criteria for drain removal following liver resection. Br J Surg. 2012; 99(11):1584-90. DOI: 10.1002/bjs.8916. View

Donadon M, Costa G, Gatti A, Torzilli G . Thoracoabdominal approach in liver surgery: how, when, and why. Updates Surg. 2013; 66(2):121-5. DOI: 10.1007/s13304-013-0244-x. View

Kyoden Y, Imamura H, Sano K, Beck Y, Sugawara Y, Kokudo N . Value of prophylactic abdominal drainage in 1269 consecutive cases of elective liver resection. J Hepatobiliary Pancreat Sci. 2009; 17(2):186-92. DOI: 10.1007/s00534-009-0161-z. View

Zhang J, Liu T, Zhou H, Fei Y, Yu X . The Safety and Efficacy of Ultrasound-Guided Bilateral Dual Transversus Abdominis Plane (BD-TAP) Block in ERAS Program of Laparoscopic Hepatectomy: A Prospective, Randomized, Controlled, Blinded, Clinical Study. Drug Des Devel Ther. 2020; 14:2889-2898. PMC: 7382581. DOI: 10.2147/DDDT.S255385. View

Martin 2nd R, Jarnagin W, Fong Y, Biernacki P, Blumgart L, DeMatteo R . The use of fresh frozen plasma after major hepatic resection for colorectal metastasis: is there a standard for transfusion?. J Am Coll Surg. 2003; 196(3):402-9. DOI: 10.1016/S1072-7515(02)01752-0. View

Biancofiore G, Blasi A, de Boer M, Franchini M, Hartmann M, Lisman T . Perioperative hemostatic management in the cirrhotic patient: a position paper on behalf of the Liver Intensive Care Group of Europe (LICAGE). Minerva Anestesiol. 2019; 85(7):782-798. DOI: 10.23736/S0375-9393.19.13468-2. View

Guillaud A, Pery C, Campillo B, Lourdais A, Sulpice L, Laurent S . Incidence and predictive factors of clinically relevant bile leakage in the modern era of liver resections. HPB (Oxford). 2013; 15(3):224-9. PMC: 3572284. DOI: 10.1111/j.1477-2574.2012.00580.x. View

Spetzler V, Schepers M, Pinnschmidt H, Fischer L, Nashan B, Li J . The incidence and severity of post-hepatectomy bile leaks is affected by surgical indications, preoperative chemotherapy, and surgical procedures. Hepatobiliary Surg Nutr. 2019; 8(2):101-110. PMC: 6503260. DOI: 10.21037/hbsn.2019.02.06. View

Mueller M, Van Remoortel H, Meybohm P, Aranko K, Aubron C, Burger R . Patient Blood Management: Recommendations From the 2018 Frankfurt Consensus Conference. JAMA. 2019; 321(10):983-997. DOI: 10.1001/jama.2019.0554. View

10.

Trzeciak S, Dellinger R, Chansky M, Arnold R, Schorr C, Milcarek B . Serum lactate as a predictor of mortality in patients with infection. Intensive Care Med. 2007; 33(6):970-7. DOI: 10.1007/s00134-007-0563-9. View

11.

Rigg J, Jamrozik K, Myles P, Silbert B, Peyton P, Parsons R . Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet. 2002; 359(9314):1276-82. DOI: 10.1016/S0140-6736(02)08266-1. View

12.

Li J, Pourrahmat M, Vasilyeva E, Kim P, Osborn J, Wiseman S . Efficacy and Safety of Patient-controlled Analgesia Compared With Epidural Analgesia After Open Hepatic Resection: A Systematic Review and Meta-analysis. Ann Surg. 2019; 270(2):200-208. DOI: 10.1097/SLA.0000000000003274. View

13.

Jacquenod P, Wallon G, Gazon M, Darnis B, Pradat P, Virlogeux V . Incidence and Risk Factors of Coagulation Profile Derangement After Liver Surgery: Implications for the Use of Epidural Analgesia-A Retrospective Cohort Study. Anesth Analg. 2017; 126(4):1142-1147. DOI: 10.1213/ANE.0000000000002457. View

14.

OGara B, Talmor D . Perioperative lung protective ventilation. BMJ. 2018; 362:k3030. PMC: 6889848. DOI: 10.1136/bmj.k3030. View

15.

Lo C, Fan S, Liu C, Lai E, Wong J . Biliary complications after hepatic resection: risk factors, management, and outcome. Arch Surg. 1998; 133(2):156-61. DOI: 10.1001/archsurg.133.2.156. View

16.

Mallett S, Sugavanam A, Krzanicki D, Patel S, Broomhead R, Davidson B . Alterations in coagulation following major liver resection. Anaesthesia. 2016; 71(6):657-68. DOI: 10.1111/anae.13459. View

17.

Jones A, Shapiro N, Trzeciak S, Arnold R, Claremont H, Kline J . Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010; 303(8):739-46. PMC: 2918907. DOI: 10.1001/jama.2010.158. View

18.

Pearse R, Harrison D, MacDonald N, Gillies M, Blunt M, Ackland G . Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review. JAMA. 2014; 311(21):2181-90. DOI: 10.1001/jama.2014.5305. View

19.

Halpern S, Leighton B, Ohlsson A, Barrett J, Rice A . Effect of epidural vs parenteral opioid analgesia on the progress of labor: a meta-analysis. JAMA. 1999; 280(24):2105-10. DOI: 10.1001/jama.280.24.2105. View

20.

Yang L, Stanworth S, Hopewell S, Doree C, Murphy M . Is fresh-frozen plasma clinically effective? An update of a systematic review of randomized controlled trials. Transfusion. 2012; 52(8):1673-86. DOI: 10.1111/j.1537-2995.2011.03515.x. View