**Question:** Contraindication to major hepatic resection for metastatic disease includes all of the following except

A. Portal hypertension
B. Severe coagulopathy
C. Cardiopulmonary dysfunction
D. Hepatic steatosis

**Core Concept:**

Major hepatic resection is a surgical procedure to remove a significant portion of the liver for the treatment of primary or secondary liver tumors. When deciding on a treatment plan, it is essential to evaluate potential contraindications to ensure patient safety and optimal outcomes. Contraindications to major hepatic resection can be broadly categorized into patient-related factors and tumor-related factors.

**Why the Correct Answer is Right:**

Contraindications to major hepatic resection should be carefully evaluated before proceeding with surgery. The correct answer, D. Hepatic steatosis, is not considered a direct contraindication to major hepatic resection. Hepatic steatosis is the presence of fat in liver cells and is often seen in patients with obesity, diabetes, or alcohol abuse. Although it can affect liver function, it is not a direct surgical risk that would prevent a patient from undergoing major hepatic resection.

**Why Each Wrong Option is Incorrect:**

A. Portal hypertension is a contraindication to major hepatic resection as it increases the risk of bleeding during the procedure and post-operative complications. Portal hypertension occurs when the pressure in the portal venous system is elevated due to liver disease or other causes.

B. Severe coagulopathy, or significant impairment of blood clotting, is another contraindication to major hepatic resection. The liver plays a crucial role in blood clotting, and severe coagulopathy can lead to excessive bleeding during and after surgery, increasing patient risk.

C. Cardiopulmonary dysfunction is a contraindication to major hepatic resection as it increases the surgical risk. Patients with significant cardiovascular or respiratory compromise may not tolerate the anesthesia, blood loss, and overall stress of major surgery.

**Clinical Pearl:**

Understanding the contraindications to major hepatic resection is essential for clinical decision-making. Although some conditions, such as hepatic steatosis, may not directly prevent surgery, they can be considered relative contraindications when combined with other factors or in severe cases. A thorough preoperative assessment should be conducted to ensure patient safety and optimal surgical outcomes.