World Library  
Flag as Inappropriate
Email this Article

Liver resection

Article Id: WHEBN0004511148
Reproduction Date:

Title: Liver resection  
Author: World Heritage Encyclopedia
Language: English
Subject: Digestive system surgery
Collection:
Publisher: World Heritage Encyclopedia
Publication
Date:
 

Liver resection

Template:Interventions infobox Hepatectomy is the surgical resection of the liver. While the term is often employed for the removal of the liver from a liver transplant recipient, this article will focus on partial resections of hepatic tissue.

History

The first hepatectomy was reported by Ichio Honjo (Kyoto University) in 1949, and Jean-Louis Lortat-Jacob in 1952, the patient being a 58-year-old woman diagnosed with colorectal cancer which had metastasized to the liver.

Indications

Most hepatectomies are performed for the treatment of hepatic neoplasms, both benign or malignant.

Benign neoplasms include hepatocellular adenoma, hepatic hemangioma and focal nodular hyperplasia.

The most common malignant neoplasms (cancers) of the liver are metastases; those arising from colorectal cancer are among the most common, and the most amenable to surgical resection. The most common primary malignant tumour of the liver is the hepatocellular carcinoma.

Hepatectomy may also be the procedure of choice to treat intrahepatic gallstones or parasitic cysts of the liver.

Partial Hepatectomies are also performed to remove a portion of a liver from a live donor for transplantation

Technique

A Hepatectomy is considered a major surgery done under general anesthesia.

Access is accomplished by laparotomy, typically by a bilateral subcostal ("chevron") incision, possibly with midline extension (Calne or "Mercedes-Benz" incision).

Hepatectomies may be anatomic, i.e. the lines of resection match the limits of one or more functional segments of the liver as defined by the Couinaud classification (cf. liver#Functional anatomy); or they may be non-anatomic, irregular or "wedge" hepatectomies.

Anatomic resections are generally preferred because of the smaller risk of bleeding and biliary fistula; however, non-anatomic resections can be performed safely as well in selected cases. For details on the variety of anatomic hepatectomies and the specific nomenclature, cf. the International Hepato-Pancreatico-Biliary Association (IHPBA) Terminology for Liver Resections

The Pringle manoeuvre is usually performed during a hepatectomy to minimize blood loss - however this can lead to reperfusion injury in the liver due to Ischemia.

Complications

Bleeding is the most feared technical complication and may be grounds for urgent reoperation. Biliary fistula is also a possible complication, albeit one more amenable to nonsurgical management. Pulmonary complications such as atelectasis and pleural effusion are commonplace, and dangerous in patients with underlying lung disease. Infection is relatively rare.

Liver failure poses a significant hazard to patients with underlying hepatic disease; this is a major deterrent in the surgical resection of hepatocellular carcinoma in patients with cirrhosis. It is also a problem, to a lesser degree, in patients with previous hepatectomies (e.g. repeat resections for reincident colorectal cancer metastases).

Results

Liver surgery is safe when performed by experienced surgeons with appropriate technological and institutional support. As with most major surgical procedures, there is a marked tendency towards optimal results at the hands of surgeons with high caseloads in selected centres (typically cancer centres and transplantation centres).

For optimal results, combination treatment with systemic or regionally infused chemo or biological therapy should be considered. Prior to surgery, cytotoxic agents such as oxaliplatin given systemically for colorectal metastasis, or chemoembolization for hepatocellular carcinoma can significantly decrease the size of the tumor bulk, allowing then for resections which would remove a segment or wedge portion of the liver only. These procedures can also be aided by application of liver clamp (Lin or Chu liver clamp; Pilling no.604113-61995) in order to minimize blood loss.

Etymology

The word "hepatectomy" is a fusion of Latin and Greek. In Latin, liver is hēpaticus, and -ectomy comes from the Greek ektomē, "to remove."

External links

  • Oncolex, the cancer encyclopedia, on liver cancer
  • Video showing laprascopic liver resection.
  • The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery – Video of Extended Left Hepatectomy procedure


Template:Ectomy, stomy, and otomy

This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and USA.gov, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for USA.gov and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
 
Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
 
By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.
 


Copyright © World Library Foundation. All rights reserved. eBooks from Project Gutenberg are sponsored by the World Library Foundation,
a 501c(4) Member's Support Non-Profit Organization, and is NOT affiliated with any governmental agency or department.