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Abstract
Hepatic resection is now considered the treatment of choice of malignant diseases of the liver and- many benign conditions of the liver.
In the past, hepatic resection, even minor resection was considered major operation which come into the fringe of the surgical practice.
Now, because of the modern surgical and anesthetic technique and the precise knowledge of the segmental nature of the hepatic anatomy, hepatic resection become a main stream operation even done in combination with other abdominal surgical procedures.
There are many indications for hepatic resection:
1. Primary malignant liver tumors.
2. Hepatic metastases e.g. colo-rectal and neuro-endocrine metastsis.
3. Some of the benign conditions of the liver.
4. Massive liver injury with denascolorization of a segment or more of liver segments.
5. In cases of living-related liver transplantation.
Hepatic resection, in the presence of cirrhosis, carries many dangers to the patient because of limited ability of regeneration, 8 -0 coagulopathy, distorted anatomy due to fibrosis and increased portal pressure.
There are many complications for hepatic resection in cirrhotics:
1. Hepatic decomposition up to liver failure.
2. Uncontrolable intra-operative and post operative bleeding.
3. Ascites and increased portal hypetension which may lead to upper GIT bleeding.
So, patients with cirrhosis must undergo through pre-operative evaluation to determine the volume and function of the remaining liver by volumetric through CT, lab investigations and indocyanine-green retention at 15 minutes specially before major resection.
In this study, we conclude that pre-operative hypoalbuminemia,pre-operative jaundice, estimated intra-operative blood loss and nonanatomical resection are string predictors for post operative morbidity and mortality.