HPB Virtual Journal Club 2016 Number 13, December 2016

An evidence based approach to technical factors in liver surgery

Welcome to our latest VJC offering. In this VJC we have focused on systematic reviews with a focus on technical issues related to liver surgery. The learning points are:

  • Routine drainage following liver resection is not associated with improved outcomes
  • Preoperative drainage of the future liver remnant is widely practiced in patients presenting with hilar cholangiocarcinoma.
  • Endoscopic approach may be associated with more early complications as compared to percutaneous approach.
  • Percutaneous catheter drainage is associated with higher success rates than percutaneous aspiration for hepatic abscesses.
  • A low CVP is associated with reduced blood loss and transfusion rates but may not reduce overall morbidity. The optimal method of CVP reduction remains to be determined.
  • Understand the available data supporting robotic liver surgery remains limited and current times seem significantly longer than that associated with open surgery. Further evidence is required to determine its true benefit
  • Understand the degree of hypertrophy that can be obtained using selective internal radiation therapy with particular emphasis on its unique time profile.