title: Complex liver resection for a large intrahepatic cholangiocarcinoma in a Jehovah's witness: a strategy to avoid transfusion.
abstract: 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.
authors: Department of Surgery, The Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA. omarbarakat@sbcglobal.net
authors: Omar
authors: O
authors: Barakat
authors: John R
authors: JR
authors: Cooper
authors: Shirley A
authors: SA
authors: Riggs
authors: John W
authors: JW
authors: Hoef
authors: Claire F
authors: CF
authors: Ozaki
authors: R Patrick
authors: RP
authors: Wood
mesh_terms: 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