All patients being considered for a hepatic resection should be

All patients being considered for a http://www.selleckchem.com/products/Gemcitabine-Hydrochloride(Gemzar).html hepatic resection should be assessed for preoperative liver dysfunction. Although most patients with colorectal cancer do not have underlying chronic liver disease, exposure to chronic chemotherapy can result in hepatic steatosis,

steatohepatitis, sinusoidal obstruction syndrome and even portal hypertension (27-31). Steatosis and steatohepatitis also frequently occur in the general population but are likely exacerbated with chemotherapy treatment. Chemotherapy Inhibitors,research,lifescience,medical associated steatohepatitis (CASH) results from chronic liver damage which can make surgical resection risky due to higher rates of postoperative liver dysfunction. There is evidence that CASH increases the risk of postoperative complications after hepatic resection for metastatic Inhibitors,research,lifescience,medical colorectal cancer (28-30). The assessment of liver function can be complex and unfortunately, blood tests are not reliable predictors of liver function. Nonetheless, all patients

should have liver chemistries, a complete blood count and a prothrombin time measured prior to surgery. These laboratory values combined with a clinical evaluation are used to calculate a Child-Pugh classification (32). We routinely perform hepatic resections on Child-Pugh class A patients with acceptable morbidity and mortality, but generally consider class B and C patients Inhibitors,research,lifescience,medical as prohibitively high operative risk. A more critical assessment is to assess the patient for portal hypertension. Patients with significant portal hypertension have a very high risk of mortality Inhibitors,research,lifescience,medical associated with hepatic resection and are generally not considered candidates (33). Splenomegaly, thrombocytopenia (<100 K/mcl) and varices on endoscopy or on CT scan are all indicative of portal hypertension. If there is doubt about the presence of portal hypertension, a more direct measurement of portal pressures can be obtained with a hepatic vein wedge pressure (34). Cross-sectional imaging should be reviewed carefully for signs of steatosis, cirrhosis and portal hypertension. MRI is effective for determining the degree of steatosis by

decomposing the liver signal into its fat and Inhibitors,research,lifescience,medical water Megestrol Acetate components (35). CT is effective at identifying varices and splenomegaly which are indicative of portal hypertension (36). No single test can reliably predict which patients have adequate hepatic reserve to tolerate a resection. However, with a comprehensive investigation of chemotherapy history, liver function tests, platelet count, Child-Pugh score, and imaging findings in conjunction with the extent of resection required the operative risk can be reasonably estimated. In patients with evidence of liver dysfunction related to chronic chemotherapy, morbidity can be minimized by decreasing the volume of resected liver with parenchymal sparing resection techniques or by increasing the volume of the future liver remnant (FLR) utilizing portal vein embolization (PVE).

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