Liver resection:


Liver resection is the surgical removal of a portion of the liver. This operation is usually done to remove various types of liver tumors or damaged portion of the liver due to any other disease(s). The goal of liver resection is to completely remove the tumor or damaged part.
It is also referred to as partial hepatectomy, which is of various forms according to the extent of of hepatic involvement. Total hepatectomy is the removal of entire liver and is performed in the setting of liver transplant, in which diseased liver is removed from the recipient (patient) or healthy liver  from a deceased donor (cadaver).  A living donor may also provide part of healthy liver which is procured through a partial hepatectomy.
When  liver resection  is performed:
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.
Partial hepatectomy may also be the procedure of choice to treat hepatic injury,  intrahepatic stones (hepatolithiasis), intrahepatic biliary stricture, cysts, exposure of bile duct during biliary reconstruction (for complex biliary injury)or irreversible damage of part of liver due to any cause. Partial hepatectomy also done for treatment early gall bladder cancer.

Can a portion of the remaining normal liver grow back?

When a portion of a normal liver is removed, the remaining liver can grow back (regenerate) to the original size within four to six weeks. Due to this fact about 80% of the healthy liver can be resected safely provided that the remaining part of the liver is healthy.   A cirrhotic liver, however, cannot grow back. Therefore, before resection is performed for HCC, functional capacity of the non-tumor portion of the cirrhotic liver should be evaluated, whether the remaining part of the liver is adequate enough to offer hepatic functional support of the patient after liver resection.

Technique:

A Hepatectomy is considered a major surgery.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  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
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 .

Complications:

Bleeding is the most feared technical complication and may be grounds for urgent reoperation.  Biloma, Biliary fistula is also are  possible complications. 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 hepatectomy e.g. repeat resections for colorectal  or other cance metastases.

Results:

Liver surgery is safe when performed by experienced surgeons with appropriate technological support. As with most major surgical procedures, there is a marked tendency towards optimal results at the hands of surgeons with high caseloads. HCC patients whose tumors are successfully resected, the five-year survival is about 30% to 40%.

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