Anesthesiologic Management During Surgery for Hepatocellular Carcinoma

Liver resection is considered a major abdominal surgery. Chronic hepatitis C is still the leading cause of chronic liver disease and is implicated in the increase in cases of HCC. Nowadays non-alcoholic fatty liver disease and alcoholic liver disease represent the second leading etiology for liver disease. During the 1970s, perioperative mortality for hepatic resection was about 20%, mostly because of uncontrollable bleeding and postoperative liver failure. Moreover, patients with liver disease such as cirrhosis have higher rates of complications and mortality. In referral centers, the mortality associated with liver resections has reduced to less than 2%, but postoperative adverse events are still high (20–50%). The Enhanced Recovery After Surgery (ERAS) Society has recently published guidelines for the fast-track management of patients undergoing liver resection. A skilled medical team with experience in treating cirrhotic patients is necessary to assure the best treatment in such a complex surgery. Moreover, improvements in surgical and anesthetic techniques made it possible to reduce perioperative mortality but patients with liver disease have significantly higher rates of complications and mortality. Only a meticulous pre-operative evaluation, the right surgical indication, and intraoperative optimization, with careful postoperative care can reduce morbidity in this surgery.