Is simultaneous hepatectomy and intestinal anastomosis safe?

BACKGROUND: To assess the safety of simultaneous, "one-stage," hepatectomy and intestinal anastomosis, we retrospectively studied 53 patients who underwent such a procedure, with 76 digestive tract sutures. They represented 80% of all the cases eligible for one-stage procedures among 332 liver resections for malignant tumors.
METHODS: The medical records of the patients were retrospectively analyzed to assess details of the surgical procedures, postoperative mortality and morbidity, and postoperative liver function, with special attention being paid to the prothrombin time and the bilirubin value on days 1, 2, 3, and 7.
RESULTS: No postoperative mortality occurred and the postoperative morbidity rate was 19%. Only 2 cases of digestive tract anastomotic leakage occurred, which led to reoperation. Hepatectomy-related complications were noted in 5 patients (3 biliary fistulas, 1 hemorrhage and 1 transient liver failure), and pulmonary infections occurred 3 times. The technical difficulties of the one-stage procedure are discussed, focusing on the choice of the incision, the risk of sepsis for the liver if there is an intestinal aperture, possible repercussions of liver impairment and hepatic pedicle clamping on bowel suture healing, and the risk of digestive fistula according to the location of the bowel suture.
CONCLUSION: It appears that this one-stage procedure is safe if the bowel is systematically cleaned before the operation, if an appropriate Rio-Branco incision is used, and if the risk of postoperative liver failure is low. It seems preferable to use intermittent hepatic pedicle clamping rather than continuous clamping (when feasible), and to temporarily protect a low rectal anastomosis with a colostomy.