Navigating Complex Challenges: Preoperative Assessment and Surgical Strategies for Liver Resection in Patients with Fibrosis or Cirrhosis
Jennifer A. Kalil,
Marc Deschenes,
Hugo Perrier,
Oran Zlotnik,
Peter Metrakos
Affiliations
Jennifer A. Kalil
Department of Surgery, Royal Victoria Hospital, McGill University Health Center, 1001 Blvd Decarie, Montreal, QC H4A 3J1, Canada
Marc Deschenes
Department of Medicine, Division of Gastroenterology & Hepatology & Transplantation, Royal Victoria Hospital, McGill University Health Center, 1001 Blvd Decarie, Montreal, QC H4A 3J1, Canada
Hugo Perrier
Department of Surgery, Royal Victoria Hospital, McGill University Health Center, 1001 Blvd Decarie, Montreal, QC H4A 3J1, Canada
Oran Zlotnik
Department of Surgery, Royal Victoria Hospital, McGill University Health Center, 1001 Blvd Decarie, Montreal, QC H4A 3J1, Canada
Peter Metrakos
Department of Surgery, Royal Victoria Hospital, McGill University Health Center, 1001 Blvd Decarie, Montreal, QC H4A 3J1, Canada
This review explores the intricacies of evaluating cirrhotic patients for liver resection while exploring how to extend surgical intervention to those typically excluded by the Barcelona Clinic Liver Cancer (BCLC) criteria guidelines by focusing on the need for robust preoperative assessment and innovative surgical strategies. Cirrhosis presents unique challenges and complicates liver resection due to the altered physiology of the liver, portal hypertension, and liver decompensation. The primary objective of this review is to discuss the current approaches in assessing the suitability of cirrhotic patients for liver resection and aims to identify which patients outside of the BCLC criteria can safely undergo liver resection by highlighting emerging strategies that can improve surgical safety and outcomes.
