Complex liver resection for a large intrahepatic cholangiocarcinoma in a Jehovah's witness: a strategy to avoid transfusion.
Although morbidity and mortality after liver resection have improved over the last two decades, complex liver resections still require perioperative blood transfusions. In this report, we describe the use of a combined left trisegmentectomy and caudate lobectomy, along with resection of the inferior vena cava, to treat a large intrahepatic cholangiocarcinoma in a Jehovah's Witness. To our knowledge, this is the first report of major liver resection for a large malignant tumor in this patient population. We also discuss the perioperative strategy and surgical technique we used to minimize blood loss and avoid transfusion. This approach could be a safe alternative for use in all patients with complex liver tumor, regardless of their religious beliefs, to reduce the risks and cost associated with blood transfusion.
Barakat
Omar
O
Department of Surgery, The Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA. omarbarakat@sbcglobal.net
Cooper
John R
JR
Riggs
Shirley A
SA
Hoef
John W
JW
Ozaki
Claire F
CF
Wood
R Patrick
RP
D000230:Adenocarcinoma / Q000601:surgery; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D018281:Cholangiocarcinoma / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006438:Hemodilution; D006801:Humans; D033221:Jehovah's Witnesses; D008099:Liver / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery; D008875:Middle Aged; D014682:Vena Cava, Inferior / Q000601:surgery