Hepatectomy is the surgical resection (removal of all or part) of the liver. While the term is often employed for the removal of the liver from a liver transplant donor, this article will focus on partial resections of hepatic tissue and

hepatoportoenterostomy A hepatoportoenterostomy or Kasai portoenterostomy is a surgical treatment performed on infants with Type IVb choledochal cyst and biliary atresia to allow for bile drainage. In these infants, the bile is not able to drain normally from the small ...

History

The first hepatectomies were reported by Dr. Ichio Honjo (1913–1987) of ( Kyoto University) in 1949, and Dr. Jean-Louis Lortat-Jacob (1908–1992) of France in 1952. In the latter case, the patient was a 58-year-old woman diagnosed with

colorectal cancer Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer from the colon or rectum (parts of the large intestine). Signs and symptoms may include blood in the stool, a change in bowel m ...

which had metastasized to the liver.

Indications

Most hepatectomies are performed for the treatment of hepatic

neoplasms A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

, both benign or malign. Benign neoplasms include

hepatocellular adenoma Hepatocellular adenoma (also known as hepatic adenoma or hepadenoma) is a rare, benign liver tumor. It most commonly occurs in people with elevated systemic levels of estrogen, classically in women taking estrogen-containing oral contraceptive me ...

, hepatic hemangioma and

focal nodular hyperplasia Focal nodular hyperplasia (FNH) is a benign tumor of the liver ( hepatic tumor), which is the second most prevalent tumor of the liver (the first is hepatic hemangioma). It is usually asymptomatic, rarely grows or bleeds, and has no malignant pot ...

. The most common malignant neoplasms (cancers) of the liver are

metastases Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, the ...

; 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. Another primary malignant liver tumor is the

cholangiocarcinoma Cholangiocarcinoma, also known as bile duct cancer, is a type of cancer that forms in the bile ducts. Symptoms of cholangiocarcinoma may include abdominal pain, yellowish skin, weight loss, generalized itching, and fever. Light colored stoo ...

. Hepatectomy may also be the procedure of choice to treat intrahepatic

gallstones A gallstone is a stone formed within the gallbladder from precipitated bile components. The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones, and choledocholithiasis refers to the presence of migr ...

parasitic Parasitism is a close relationship between species, where one organism, the parasite, lives on or inside another organism, the host, causing it some harm, and is adapted structurally to this way of life. The entomologist E. O. Wilson has ...

cysts of the liver. Partial hepatectomies are also performed to remove a portion of a liver from a living donor for transplantation.

Technique

A hepatectomy is considered a major surgical procedure performed under general anesthesia. Access is accomplished by

laparotomy A laparotomy is a surgical procedure involving a surgical incision through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy. Origins and history The first successful laparotomy was performed without ane ...

, historically by a bilateral subcostal ("chevron") incision, possibly with midline extension (Calne or "Mercedes-Benz" incision). Nowadays a broadly used approach for open liver resections is the J incision, consisting in a right subcostal incision with midline extension. The anterior approach, one of the most innovative, is made simpler by the liver hanging maneuver. In most recent years the minimal invasive approach, consisting in laparoscopic and then robotic surgery, has become increasingly common in liver resective surgery. 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. The Pringle manoeuvre is usually performed during a hepatectomy to minimize blood loss - however this can lead to

reperfusion injury Reperfusion injury, sometimes called ischemia-reperfusion injury (IRI) or reoxygenation injury, is the tissue damage caused when blood supply returns to tissue ('' re-'' + ''perfusion'') after a period of ischemia or lack of oxygen (anoxia or hy ...

in the liver due to Ischemia.

Complications

Bleeding Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, v ...

is a feared technical complication and may be grounds for urgent reoperation. It has been demonstrated that the intraoperative blood loss during liver resections affects the outcome in terms of postoperative morbility and mortality. Biliary fistula is also a possible complication, albeit one more amenable to nonsurgical management. Pulmonary complications such as

atelectasis Atelectasis is the collapse or closure of a lung resulting in reduced or absent gas exchange. It is usually unilateral, affecting part or all of one lung. It is a condition where the alveoli are deflated down to little or no volume, as distinct ...

and pleural effusion are commonplace, and dangerous in patients with underlying lung disease. Infection is relatively rare. Liver failure is the most serious complication of liver resection; this is a major deterrent in the surgical resection of hepatocellular carcinoma in patients with

cirrhosis Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, and end-stage liver disease, is the impaired liver function caused by the formation of scar tissue known as fibrosis due to damage caused by liver disease. Damage causes tissue repai ...

. It is also a problem, to a lesser degree, in patients with previous hepatectomies (e.g. repeat resections for reincident

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 derived from Greek. In Greek liver is ''hepar'' and -ectomy comes from the Greek ''ektomē'', "to remove."

References

External links

Oncolex, the cancer encyclopedia, on liver cancer

Video showing laprascopic liver resection.

* [http://www.pie.med.utoronto.ca/tvasurg/TVASurg_content/surg/PL_standardLeftHepatectomy.html The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery – Video of Standard Left Hepatectomy procedure]
The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery – Video of Standard Right Hepatectomy procedure

{{Authority control Surgical oncology Hepatology Accessory digestive gland surgery