Liver Resection

About Liver Resection

Liver resection, or hepatectomy, removes part of the liver. It is performed mainly for colorectal cancer that has spread to the liver, hepatocellular carcinoma, bile duct cancer and some benign tumors such as hepatic adenoma. Surgery is possible because the liver has a remarkable capacity to regenerate, with the remaining liver growing back toward its original volume over the following weeks to months. Whether a resection is safe depends largely on the size and function of the future liver remnant, the part that will remain, and a larger remnant is needed when the liver is damaged by cirrhosis or chemotherapy. When the remnant would be too small, portal vein embolization of the side to be removed can stimulate the remaining liver to grow before surgery. The Couinaud classification, described by the French surgeon Claude Couinaud in the 1950s, divides the liver into eight functionally independent segments, each with its own blood supply and bile drainage, which allows anatomical resections ranging from a single segment to a right or left hepatectomy or an extended trisectionectomy. The liver tissue is divided with energy devices, ultrasonic dissectors or staplers. The Pringle maneuver, temporary clamping of the blood vessels entering the liver, and anesthesia that keeps central venous pressure low help reduce bleeding. Complications include post hepatectomy liver failure, bile leak, bleeding, infection and fluid around the lungs. Outcomes are best at experienced centers, and laparoscopic and robotic liver surgery are increasingly used.