Special therapeutic procedures
Liver resection is the chosen procedure for patients who suffer from primary or secondary tumors located at this organ. The mortality rate in this procedure has decreased remarkably in the last 25 years. Nowadays, the mortality in our service after 1,200 resections is less than 1%, in cases of parenchymas with no functional disorders (no cirrhosis nor cholestasis) or in parenchymas with resections of less than 60% of liver volume. Patients with big or multiple liver injuries in which resection of 5 liver segments is necessary, or in those cases with a liver volume over 60%, the surgical risk is greater than the previous mentioned, but still quite low -this is, 5%. The main cause for this surgical risk is postoperative liver failure provoked by the short liver remainder.
Preoperative portal embolization is the procedure done by the Vascular and Interventionist Radiology Deparment in our Hospital in order to prepare the liver parenchyma for surgery. The consequence of this preparation can be seen after the tumor excision in the anatomic and, most of all, functional hypertrophy. The results of our experience over 130 cases guarantee the efficiency of this surgical technique.
The General and Digestive Surgery Department at Madrid Norte Sanchinarro Hospital performs the preoperative portal embolization under the following indications:
- Liver resections of 70% liver volume or more.
- Liver resections with a resection volume of 60% or less in patients with (previously drained) obstructive jaundice, severe cholestasis or any other parenchymatous disorder.
- Liver resections with a resection volume of 60% or smaller than the one in patients who are going to undergo intraoperative prolonged normothermic ischemia for technical reasons.
- Lobar liver resections in over 70 year-old patients.
Under general anaesthesia, a radiologic control and transhepatic puncture of the portal vein, correspoding to the liver lobe in which the injury is located, is performed. After visualizing the liver portal by means of portography, the portal branches corresponding to the liver area that is going to be resected are selectively conducted introducing the same particles that facilitate the venous embolization.
After checking the ultrasonography and the laboratory tests to see the alterations provoked by the surgical procedure, the patient is discharged from hospital in less than 24 or 48 hours if there are no complications.
An axial tomography is done 4 weeks after the portal embolization and the liver volume is measured. If the liver parenchyma has increased over 20% of what was previously seen, an extended liver resection is recommended.
- Postoperative complications derease, specially liver failure and risks of liver surgery
- The need of blood transfusion products during the surgical process dicreases.
- It globally reduces their stay at hospital.
- It prevents from undergoing unnecessary surgery to patients with high risk of liver failure and offers them therapeutic options