Perioperative Management of Complex Hepatectomy for Colorectal Liver Metastases: The Alliance between the Surgeon and the Anesthetist.
Enrico GiustinianoFulvio NisiLaura RocchiPaola C ZitoNadia RuggieriMatteo M CiminoGuido TorzilliMaurizio CecconiPublished in: Cancers (2021)
Hepatic resection has been widely accepted as the first choice for the treatment of colorectal metastases. Liver surgery has been recognized as a major abdominal procedure; it exposes patients to a high risk of perioperative adverse events. Decision sharing and the multimodal approach to the patients' management are the two key items for a safe outcome, even in such a high-risk surgery. This review aims at addressing the main perioperative issues (preoperative evaluation; general anesthesia and intraoperative fluid management and hemodynamic monitoring; intraoperative metabolism; administration policy for blood-derivative products; postoperative pain control; postoperative complications), in particular, from the anesthetist's point of view; however, only an alliance with the surgery team may be successful in case of adverse events to accomplish a good final outcome.
Keyphrases
- minimally invasive
- patients undergoing
- end stage renal disease
- liver metastases
- chronic kidney disease
- ejection fraction
- newly diagnosed
- coronary artery bypass
- cardiac surgery
- prognostic factors
- postoperative pain
- public health
- social media
- mental health
- atrial fibrillation
- pain management
- acute coronary syndrome
- surgical site infection
- chronic pain
- quality improvement
- water soluble