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Current technical aspects of oncological hepatic surgery.
Ahmed I Salem1, Emily R Winslow
1Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue BX7375 CLINICAL SCIENCE CNTR Madison, WI 53792-7375, USA. winslow@surgery.wisc.edu.
Summary
Recent advances in oncological hepatic surgery improve patient care and outcomes. New techniques like intraoperative ultrasonography and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) enhance surgical strategy and results for liver cancer patients.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Major liver resections are increasingly common due to advances in oncological hepatic surgery.
- Modern hepatic surgery has improved preoperative, intraoperative, and postoperative patient care, reducing morbidity and mortality.
- This review focuses on recent advancements in oncological hepatic surgery.
Purpose of the Study:
- To review recent advances in oncological hepatic surgery.
- To highlight improvements in patient care and surgical outcomes.
- To discuss novel techniques and assessment tools in liver cancer surgery.
Main Methods:
- Literature review of peer-reviewed articles and journals.
- PubMed database search for studies up to June 2016.
- Critical assessment of over 50 recent publications from high-impact journals.
Main Results:
- Child-Turcotte-Pugh classification remains the most reliable tool for preoperative liver function assessment.
- Intraoperative ultrasonography enhances sensitivity and specificity in liver assessment, altering surgical strategy in 27.2% of cases.
- Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) offers an alternative for patients with marginally resectable tumors and inadequate future liver remnant.
Conclusions:
- Comprehensive assessment and appropriate technique selection improve oncological outcomes in selected liver cancer patients.
- Patients with marginal future liver remnant volumes can now benefit from expanded surgical interventions.
- These advancements significantly improve morbidity and mortality rates in patients undergoing major liver resections.