Major liver resection: perioperative course and management.

This report investigates the perioperative course in 81 consecutive major liver resections, performed mainly because of primary liver cancer or colorectal liver secondaries. The liver was resected transabdominally with or without prior ligation of hilar structures. Intravenous nutrition consisted of 10% dextrose alone and was started preoperatively. Albumin or plasma was used rarely and only in conjunction with massive intraoperative transfusion of blood. Major complications, including four operative deaths (4.9%), consisted of bleeding and/or infection in eight (10%) patients and overt liver failure in two patients (2%) and occurred only after right and extended right lobectomies. Intraoperative blood loss was significantly larger in patients with postoperative complications than in patients with an uneventful postoperative course. The direct parenchymal approach was associated with a shorter operative time and an unchanged intraoperative bleeding. Coagulopathy and hypoalbuminemia did not cause any problems. Blood glucose levels were stable, and no patient suffered from hypoglycemia. It is concluded that major liver resection should be based on prevention of intraoperative bleeding and that preresection ligation of hilar structures offers no advantage in this respect. Infusion of hypocaloric glucose solutions should be started the day before operation, and routine administration of other nutrients does not seem necessary.