Perioperative effects of hepatic resection surgery on hemodynamics, pulmonary fluid balance, and indocyanine green clearance.
BACKGROUND
Major liver resection is a routine surgical treatment, but hemodynamic and pulmonary complications are common. We investigated the effects of hepatic resection on hemodynamics and pulmonary and liver function.


METHODS
Twelve patients who underwent major liver resection due to primary liver tumor, liver metastasis, or hemangioma were investigated prospectively and consecutively. Six patients who underwent gastrectomy due to gastric cancer served as a control group. Hemodynamic parameters (cardiac index, intrathoracic blood volume, mean arterial blood pressure), extravascular lung water, and indocyanine green clearance were measured after the induction of general anesthesia, during the preparation period, during total hilar clamping ("Pringle's maneuver"), at the end of surgery, and 24 and 72 h after surgery.


RESULTS
In contrast to gastrectomy, patients who underwent liver resection developed a hyperdynamic circulatory state (cardiac index 72 h postoperatively: 4.6+/-1.2 l/m(2) vs. 3.6+/-0.6 l/m(2)). Simultaneously we observed a significant increase in extravascular lung water in the liver resection group, indicating a moderate pulmonary edema. Indocyanine green clearance did not deteriorate following liver resection.


CONCLUSIONS
After liver resection the physiological response resulted in elevated cardiac output and moderate pulmonary edema. Dynamic liver function was elevated within 24 h due to an increase in perfusion and regeneration activity of the remaining parenchyma.
Thasler
Wolfgang Erwin
WE
Klinik für Chirurgie, Universitätsklinikum, 93042 Regensburg, Germany.
Bein
Thomas
T
Jauch
Karl-Walter
KW
D000328:Adult; D000368:Aged; D004396:Coloring Agents / Q000493:pharmacokinetics*; D005260:Female; D006391:Hemangioma / Q000503:physiopathology* / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology*; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007208:Indocyanine Green / Q000493:pharmacokinetics*; D007431:Intraoperative Complications; D008107:Liver Diseases / Q000209:etiology* / Q000503:physiopathology*; D008113:Liver Neoplasms / Q000503:physiopathology* / Q000556:secondary / Q000601:surgery*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology* / Q000503:physiopathology*; D013997:Time Factors
D004396:Coloring Agents; D007208:Indocyanine Green