Surgical management of hepatic malignancy

Over the past twenty-five years, hepatic resection has evolved from a high risk, resource-intensive procedure with limited application to a safe and commonly performed operation with broad indications. This period has seen dramatic improvements in perioperative outcome, including reductions in mortality, blood loss, transfusion rates, and hospital stay. These improved perioperative results are largely responsible for the emergence of hepatic resection as a viable and effective treatment option for selected patients with 1 degree and 2 degrees hepatobiliary malignancy. Continued advances in imaging technology, along with a heightened awareness of the clinical and tumor-related variables that dictate outcome, have allowed better preoperative assessment of disease extent and improved patient selection. Advances in other areas, such as minimally invasive and ablative techniques, have increased the treatment options and have had some impact on the approach to patients with malignant hepatobiliary disease; however, resection remains the most effective therapy. Although the long term results after resection are better than with other modalities, recurrence rates remain high, and further improvements in survival will require more effective systemic agents. As better adjuvant and neo-adjuvant therapies emerge, the results of resection are likely to improve and the indications for its application perhaps will extend to patients currently considered to have unresectable disease.