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Overview of hepatic resection

Authors
Steven A Curley, MD, FACS
Evan S Glazer, MD, PhD, MPH
Section Editor
Stanley W Ashley, MD
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Hepatic (liver) resection is needed to manage many types of pathology, malignant and benign. Planning hepatic resection needs to take into account the nature of the lesion and its location within the liver, the patient's anatomy, and the quality and volume of the liver tissue that will remain after resection. Perioperative outcomes for hepatic resection have improved due to better surgical techniques that take advantage of the segmental anatomy of the liver, improved techniques for control of bleeding, and improved intensive care. Hepatic resection that is performed in high-volume centers by specially trained hepatobiliary surgeons is associated with better outcomes [1-3].

Surgical resection of the liver and complications of liver resection will be reviewed here. Specific management of pathologies that indicate a need for liver resection and disease-specific outcomes related to liver resection are discussed in separate topic reviews. (See "Surgical management of potentially resectable hepatocellular carcinoma" and "Surgical management of gallbladder cancer" and "Surgical techniques for managing hepatic injury" and "Treatment of localized cholangiocarcinoma: Adjuvant and neoadjuvant therapy and prognosis".)

LIVER ANATOMY AND PHYSIOLOGY

The liver is divided into two lobar segments (right and left), and further subdivided into eight (Couinaud) segments based upon vascular supply and bile duct distribution (figure 1). The segmental anatomy of the liver is the basis for the various types of anatomic hepatic resections (figure 2). The surgical anatomy of the liver and types of hepatic resection are discussed in detail elsewhere. (See "Hepatic resection techniques", section on 'Surgical anatomy'.)

Liver function and regeneration after resection — The hepatocytes perform a variety of metabolic functions including:

Removing metabolic waste products, hormones, drugs, and toxins

                           

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Literature review current through: Nov 2016. | This topic last updated: Wed Aug 31 00:00:00 GMT+00:00 2016.
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