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[Anatomical and atypical liver resections].
1Klinik und Poliklinik für Allgemeine und Viszerale Chirurgie, Friedrich-Schiller-Universität, Jena. scheele@bach.med.uni-jena.de
Summary
Anatomical liver resection offers superior tumor clearance for hepatic tumors. Non-anatomical approaches are suitable for specific benign conditions and complex cases, improving patient outcomes.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Liver Anatomy
Background:
- Liver resection is a key treatment for hepatic tumors and other conditions.
- Understanding intrahepatic segmentation based on portal structures and hepatic veins is crucial.
Purpose of the Study:
- To highlight the advantages of anatomical liver resection for tumor clearance and long-term outcomes.
- To discuss indications for both anatomical and non-anatomical resection techniques.
- To review essential techniques for safe and effective liver resections.
Main Methods:
- Anatomical approach based on intrahepatic segmentation.
- Description of standard, sector-orientated, and segment-orientated resections.
- Discussion of indications for non-anatomical procedures.
- Review of intraoperative techniques: ultrasound, low central venous pressure, hilar clamping, ischemic preconditioning.
Main Results:
- Anatomical resections provide superior tumor clearance, especially for malignant tumors respecting intrahepatic boundaries.
- Non-anatomical resections are indicated for benign tumors, HCC in cirrhosis, re-resections, biopsies, and trauma.
- Optimized surgical techniques enhance safety and oncological effectiveness.
Conclusions:
- Anatomical liver resection is a preferred approach for malignant hepatic tumors due to improved outcomes.
- Non-anatomical resections have specific, rational indications.
- Future strategies like portal vein embolization and multidisciplinary trials may further enhance resectability and outcomes.