Surgery of liver tumours

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Diagnostic Imaging

Background:

• The liver's segmental anatomy facilitates surgical resection.
• Management of intrahepatic lesions requires a low-risk diagnostic approach that preserves options for subsequent excision.
• Percutaneous biopsy of operable tumors may increase morbidity and spread.

Purpose of the Study:

• To outline the principles of investigating and managing intrahepatic lesions.
• To discuss the surgical management of primary liver cancers like hepatocellular carcinoma (HCC) and secondary liver tumors.
• To detail the risks and outcomes associated with different types of liver resections.

Main Methods:

• Review of diagnostic modalities including ultrasonography, CT scanning, and arteriography for assessing operability.
• Discussion of surgical resection as the primary curative treatment for HCC and select metastatic diseases.
• Analysis of operative morbidity and mortality based on resection extent and liver reserve.

Main Results:

• Surgical excision offers the only hope of cure for HCC, with a 35% 5-year survival in non-cirrhotic patients.
• Fibrolamellar HCC and resectable colorectal metastases represent potentially curable conditions.
• Major hepatic resection carries a 3-5% mortality, while hilar resections have a 10-12% mortality.

Conclusions:

• Resectional surgery is the mainstay for potentially curable liver tumors.
• Careful preoperative evaluation is essential to optimize surgical outcomes and minimize complications.
• Liver transplantation has limited current benefit for liver neoplasms compared to resection, except in specific incidental findings.