1998 Distinguished Academician Lecture: hepatic resection--a Western perspective

Area of Science:

• Hepatobiliary Surgery
• Transplant Surgery
• Surgical Anatomy

Background:

• Liver resection has evolved significantly over the past two decades, transitioning from a high-risk procedure to a common operation with reduced morbidity and mortality.
• Understanding liver functional anatomy was crucial for the shift from non-anatomic to anatomic resection techniques.
• Early experience focused on major hepatectomies, but segment-oriented resections are now more prevalent.

Discussion:

• Indications for 825 elective liver resections included metastases (46%), primary malignancy (30%), and non-malignant disease (24%).
• Emergency hepatectomies (98 cases) were predominantly for severe liver trauma (two-thirds).
• Overall 30-day mortality was 3.6%, with lower rates for elective (2.9%) and non-jaundiced patients (1.6%).

Key Insights:

• The last 300 elective resections showed a significant improvement with only one postoperative death and zero median blood transfusion.
• Innovative graft reduction techniques have been pivotal in advancing liver transplantation.
• Reduced adult donor livers enabled safe implantation of the left lateral segment in infants, pioneering split-liver and living-related transplantation.

Outlook:

• Continued refinement of anatomic and segment-oriented resection strategies will further enhance patient outcomes.
• Further development of graft modification techniques holds promise for expanding liver transplantation accessibility.
• The evolution of liver resection and transplantation techniques underscores the dynamic progress in hepatobiliary surgery.