J.H. Louw Memorial Lecture. Liver surgery: 'traveller, there is no path, a path is made by walking'

Liver resection today is a product of rapid development over the past two decades. The description of the functional anatomy of the liver was the foundation of modern liver surgery. However, it has been the technological advances in radiology that have had the biggest impact in the management of hepatobiliary disease. Major hepatectomies dominated the earlier experience of modern liver surgery, but segment-orientated resections now play a more prominent role. Resections may be performed for both malignant and benign lesions or as an emergency procedure for trauma or other catastrophic event. At Princess Alexandra Hospital, Brisbane, 1,108 liver resections have been undertaken. Of the elective resections, 45% were for metastases, 29% for primary malignancy and 26% for benign disease. Two-thirds of the 102 emergency hepatectomies were for severe liver trauma. The 30-day mortality was 3.2% for the total series, 2.6% for the elective cases and 1.5% for the elective, non-jaundiced patients. Innovative graft reduction techniques have become a major component in liver transplantation. The successful transplantation of a reduced-size segmental graft from an adult donor liver to an infant paved the way for other procedures such as split-liver, auxiliary partial orthotopic and living-donor transplantation.