Perioperative management - Right hemihepatectomy

Malignant tumors:

• Liver metastasis
• Hepatocellular carcinoma (HCC)
• Cholangiocellular carcinoma (CCC)

Benign tumors:

• Adenoma
• Focal nodular hyperplasia (FNH)

• Impaired liver function with insufficient residual functionality, e.g., cirrhosis, particularly Child-Pugh-Turcotte B + C
• Systemic infection
• Diffuse metastasis also in left lobe
• Invasion of the diaphragm or hepatoduodenal ligament
• Invasion of the vena cava or hepatocaval confluence
• Other distant metastasis
• Uncontrolled primary

• Confirmation/localization of tumor Abdominal US, multiphase CT study, upper quadrant CT-angiography, possibly: MRI, contrast enhanced US, ERCP with cytology, FNA (US or CT guided); intraoperative US
• Ruling out (additional) distant metastasis CT-chest, intraoperative US
• Lab panel: RBC, albumin, bilirubin, gamma-GT, AP, ALT, AST, coagulation, creatinine, electrolytes, blood group, antibody screening test, tumor markers
• ECG, possibly other cardiopulmonary function studies

• Order 6 packed red cells
• Check if ICU bed is available
• Preoperative single-shot 2nd generation cephalosporin half an hour before skin incision

Recurrence, seroma, (secondary) bleeding, hematoma, need for blood transfusion with corresponding risks, necrosis of hepatic parenchyma, biliary fistula, bilioma, biliary peritonitis, bile duct stenosis, hemobilia, liver failure with coma, arrhythmias, cardiovascular disorders, thromboembolic complications, positioning injuries, electrosurgery injuries, injury of adjacent organs, pleural effusion requiring drainage, abscess, secondary wound healing, abdominal wound dehiscence, incisional hernia, adhesions, revision surgery, death