Pushing back the frontiers of resectability in liver cancer surgery

Thanks to advances in surgical technique, anaesthesia and peri-operative care, hepatic resection has evolved from a rare procedure with an associated mortality rate of up to 20% to a routine surgery carried out in high volume liver units with an operative risk of less than 5%. This review concentrates on the techniques employed in radical hepatic resection, considering in particular: (1) The feasibility of extended hepatic parenchymal resections; (2) The treatment of lesions compromising the hepatic in-flow; and (3) The treatment of lesions compromising the hepatic out-flow. We discuss how these aims can be achieved by: minimizing the blood loss; minimizing the remnant liver parenchymal injury; performing an adequate oncological resection; and creating adequate venous out-flow reconstruction, using case series and case histories to illustrate these points.