PubMed · 8031653
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W J Hodgson. 1994. Parenchymal dissection techniques.. https://doi.org/10.1007/978-1-4615-2604-9_18
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The postoperative complications, morbidity and mortality of hepatopancreatoduodenectomy (HPD) are reviewed based on reports by the Japanese Biliary Surgery Association, Japanese Pancreatectomy Association, and leading surgeons. Postoperative hepatic failure, the most important and lethal complication, is significantly correlated with patient age (older than 70 years), resected hapatic volume (hepatic bisegmentectomy or greater), combined resection of the portal vein, or temporal bypass of portal blood flow. In patients who undergo HPD with more than bisegmentectomy, the operative mortality rate is high rate, with reports of 39.7%, 23.0%, 12.5%, and 38.0%. To reduce the morbidity and mortality rates after HPD, it is important to avoid intraoperative hepatic ischemia and to maintain sufficient hepatic blood flow and high oxygen saturation of portal blood postoperatively using a respirator and inotropic agents.
During the period from 1997 to 2000, the total of 129 liver operations were performed at the 2nd Surgical Department of the Masaryk's University in Brno. Malignant tumours were present in 91 cases. In-hospital mortality in patients operated on for malignant liver tumours was 2.1%. No case of death was caused by liver insufficiency. Examination of liver function by use of indocyanine green (ICG) enabling the determination of the extent of possible resection, contributes to the lowering of postoperative morbidity and mortality. The rate of indocyanine green retention up to 6% does not limit the extent of resection, the retention rate up to 15% allows bisegmentectomy or a minor surgery, the retention rate up to 20% allows segmentectomy at the most, and the retention rate up to 30% enables superficial excisions only.