[Segment-oriented liver resection. Principles--technic--status]

Complete surgical resection represents the only treatment for malignant tumors of the liver which offers the chance of long-term tumor-free survival. The segment orientated approach appears to be a fundamental improvement in preventing incomplete tumor removal as well as wastage of non-involved hepatic tissue. This resection technique is particularly based on a detailed knowledge of intrahepatic vascular anatomy and its variations. The use of modern diagnostic and surgical aids such as intraoperative ultrasound and liver transsection using the "ultrasonic-aspirator" expedites such technically sophisticated types of liver resection and permits their save and low risk implementation. The clinical relevance of this approach is analyzed on 452 hepatic resections consecutively performed from October, 1984, through December, 1988. 312 patients suffered from malignant disease, 224 of them from metastatic tumor. There were 159 segment orientated procedures as opposed to 167 common hepatectomies, and 126 non-anatomical resections. In 235 patients the procedure was restricted to the liver, whereas in 48 cases a perihepatic extension, and in 169 distant extrahepatic procedures were performed as well. The overall 30 days mortality was 4.4%, ranging from 50% in 8 trauma cases to 2% in 204 elective procedures restricted to a non-cirrhotic liver. Segment orientated modifications reduced the risk of hepatic failure and consecutive mortality particularly associated with right lobectomy and hepatectomy, respectively. In turn, non-radical tumor removal was significantly diminished if compared to both common as well as non-anatomical resections.