ABSTRACT
Preop In cancer patients, a triphasic helical C T scan of the liver and porta hepatis is done
for assessment of local tumor extension. Percutaneous transhepatic cholangiography (PTC) and/or endoscopic retrograde cholangiopancreatography (ERCP) are done to demonstrate the extent and location of tumors or strictures of the biliary system and for preoperative relief o f biliary obstruction. Placement of the percutaneous stent through the hepatic duct stricture or tumor into the duodenum will facilitate identification and dissection at surgery. Magnetic resonance imaging may be required to delineate the relation o f a tumor to the main vascular structures within the porta hepatis. On the morning of surgery, patients receive preoperative antibiotics and an epidural catheter for intraoperative and postoperative analgesia. Deep vein throm bosis (DVT) prophylaxis with subcutaneous heparin and/or sequential compression devices is used according to the patient s risk factors for thromboembolus.
