Dr. Swapnil Kapote : Left hepatectomy done on 19th September at AIMS Hospital

A 60-year-old Male patient presented with chief complaints of pain and fullness in stomach with black colored stool. No H/O medical co-morbidities. Upon investigation he was found to have hepatocellular carcinoma of left lobe with involvement of lesser curvature of stomach. Relevant investigations are as follows:-

CT abdomen- Lobulated mass of 10 x 15 x 12 cm in left lobe of liver involving entire segment II & III with lesser curvature of stomach.

  • Biopsy- Hepatocellular carcinoma
  • AFP- 3100 IU/ML
  • CEA- 1.3
  • SGOT- 78
  • SGPT- 49

Anesthesia evaluation done and patient was posted for left hepatectomy by Gastro Surgeon Dr. Hunaid Hatimi and Onco Surgeon Dr. Swapnil Kapote. Patient induced with weight adjusted doses of propofol and scoline and maintained on isoflurane, atracurium and oxygen nitrous oxide for general endotracheal anesthesia. Hemodynamic monitoring done using arterial line. Intr-operative blood loss was approximately 4.5 liters which was replaced with 4 liters of crystalloids, 3 point PCV and 2 point FFP. Surgical duration 5 hrs. Hemodynamic stability was achieved with timely and opt use of ionotrops and maintaining satisfaction urine output.

Post operatively patient was shifted to ICU for elective ventilation over night. 2 point PCV and 2 point FFP were transfused post-operatively and patient was extubated on 2nd day after adequate tapering of inotropes. Orals were started on 3rd post-operative day and patient was shifted out of ICU after adequate mobilization. Recovery was assisted with IV amnio acids, albumin and with high protein diet later on. Patient’s recovery was well managed and then he was discharged on 10th day.