Longterm Complications Of Hepatic Resection

Despite the myriad of possible acute complications associated with hepatic resection, there are few long-term sequelae once the liver has regenerated. There is no particular evidence that the regenerated hepatic parenchyma is more fragile or susceptible to hepatotoxic drugs. Repeat hepatic resection may even be done safely if the indications and circumstances warrant it (18-20). Patients certainly can develop wound problems such as hernias or chronic pain. They infrequently develop biliary strictures as a result of chronic inflammation, iatrogenic low-grade ischemia, or intrarterial chemotherapy. The clinician caring for these patients should be aware that the orientation of portal structures in the hilum is frequently rotated following a major resection and regeneration, as this knowledge can be helpful interpreting radiological studies.

Still, the most common late problem encountered by patients who have undergone some form of hepatectomy is a recurrence of the disease that precipitated the need for the original hepatectomy. For example, approx 30% of equivalently selected patients who have undergone either hepatectomy or ablations for colorectal liver metastases will have the first recurrence of their tumor confined to the liver (21-23). Patients who have undergone a hepatectomy for hepatoma usually face not only the risk of recurrence of their tumor, but also the progression of cirrhosis and complications of portal hypertension. Nevertheless, the risk of tumor reappearance in the liver of patients with severely cirrhotic livers is very high (24). Many of these "recurrences" may really be new tumors arising in the damaged field, but their appearance within 5 yr of successful resection or ablation is unfortunately quite reliable and ultimately lethal.

Patients are often followed for recurrence of their tumors with serum markers (CEA for colorectal, CA 19-9 for biliary, and alpha fetoprotein for hepatocellular cancer) and with CT scans or MRI. Patients who have undergone an ablation of their tumor should have a new "baseline" CT or MRI obtained at 6-8 wk postoperatively. Subsequent scans should confirm that the ablation lesion is either the same size or smaller. Growth of the ablation lesion suggests a local recurrence at that site as opposed to the growth of other, previously unappreciated, hepatic metastases. PET scans will probably be a worthwhile way to evaluate suspicious ablation sites in the near future. The value of aggressive radiological follow-up depends to some extent on what can be done about a recurrence of the tumor when it is found.

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