HPB Virtual Journal Club Number 11, March 2016

Optimising perioperative care for patients undergoing hepatectomy

Welcome to the latest VJC focusing on perioperative care for patients undergoing hepatectomy.

Outcomes from hepatic resection have improved exponentially over the last two decades, much of this has been due to improvements in perioperative care due to the improved understanding of the underlying haemodynamic and pathophysiological changes associated with hepatic resection. In this VJC a selection of the latest articles including a two systematic reviews and two randomised trials are presented. The learning objectives are as follows:

  • To understand the adverse effect preoperative anaemia has on outcomes following hepatectomy.
  • To understand the potential benefits of portal vein embolization may have on the immediate function of the remnant liver raising the possibility that the indication for PVE should be increased.
  • To understand that when calculating FLRV estimated volumes may vary from measured volumes by more than 5% which may be important for clinical decision making in up to 1/3 of patients..
  • To understand the importance of CVP in reducing blood loss during hepatectomy but the optimal method for reduction remains unclear.
  • To understand that for laparoscopic liver surgery stoke volume variation may be useful in monitoring cardiac preload.
  • To understand the use of fibrin patch may help reduce intraoperative bleeding during hepatectomy.
  • To understand the significance of changes in Phosphate and Creatinine levels in the early post-operative period following hepatectomy.
  • To understand the benefits of enhanced recovery surgery following hepatic resection.