Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Metastasis (colon, breast, neuroendocrine).Hepatocellular carcinoma.Cholangiocarcinoma.Hepatoblastoma.Gallbladder carcinoma.Hepatic sarcoma.Adenoma.Biliary cystadenoma.Symptomatic hemangioma or focal nodular hyperplasia.Hepatic tumor of unknown etiology. ++ Distant metastatic disease for primary liver tumors.Presence of extrahepatic metastases for metastatic lesions (relative).Severe medical comorbidity.Inability to achieve negative margins.Insufficient estimated liver remnant following resection.Significant cirrhosis or portal hypertension. ++ The patient should be supine with arms extended. ++ Adequacy of resuscitation should be monitored closely, and any concern for bleeding should be promptly evaluated.Assessment of liver function should be followed closely in the postoperative period (neurologic status, coagulation factors, liver function tests).Benzodiazepines and hepatotoxic medications should be avoided in the early postoperative period.Deep vein thrombosis prophylaxis should be provided.Oral diet can be advanced as tolerated; if not tolerated, other forms of enteral nutrition should be initiated.Close monitoring for possible complications is required (see later). ++ Bleeding.Bile leak. Manifested by bile staining in drains or evidence of cholestasis on liver function tests.Symptoms may involve increased abdominal pain, ileus, fever, or tachycardia.Many bile leaks are self limited and can be treated with percutaneous drainage alone.More severe bile leaks will require endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and biliary stent placement, or placement of a percutaneous transhepatic cholangiocatheter (PTC) in situations where ERCP is not technically possible.Abscess or infection.Hepatic dysfunction, which can be manifested by the following: Acidosis.Impaired mental status.Hypoglycemia.Coagulopathy.Hyperbilirubinemia.Transaminitis.Renal failure.Predisposition to infection.Care is primarily supportive, but evaluation should be performed to exclude major biliary or vascular complications.Tumor recurrence.Embolism (usually intraoperative). Can be diagnosed using intraoperative transesophageal echocardiography if necessary.Prevented by optimizing CVP during parenchymal dissection. Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.