Hepatic malignancy: challenges and opportunities for the surgeon

The management of hepatic malignancy has changed from a previously nihilistic approach to a more positive one. Every patient should be considered for curative surgical resection, either at first presentation or after cytoreductive treatment. The surgeon is faced with the challenge of adapting modern surgical techniques to increase resectability rates. Although the majority of patients are unsuitable for resection, effective palliation can be achieved using a wide variety of techniques. The rational implementation of these palliative modalities requires a multidisciplinary approach which provides the surgeon with the opportunity to play a key role in the ongoing management of these patients.