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Hepatectomy

Hepatectomy is the surgical resection of the liver.

While the term is often employed for the removal of the liver from a liver transplant donor, this article will focus on partial resections of hepatic tissue and hepatoportoenterostomy.

Liver resection is the optimal treatment for patients with primary or metastatic liver malignancies.

Most hepatectomies are performed for the treatment of hepatic neoplasms, both benign or malign.

Benign neoplasms include adenomas, hepatic hemangiomas and focal nodular hyperplasia.

The most common malignant neoplasms of the liver are metastases.

Liver metastases arising from colorectal cancer are among the most common, and the most amenable to surgical resection.

The most common primary malignant tumor of the liver is the hepatocellular carcinoma, and another primary malignant liver tumor is the cholangiocarcinoma.

Hepatectomy may also be the procedure of choice to treat intrahepatic gallstones or parasitic cysts of the liver.

Partial hepatectomies are also performed to remove a portion of a liver from a living donor for transplantation.

A hepatectomy is a major surgical procedure performed under general anesthesia.

Access to the liver accomplished by laparotomy, historically by a bilateral subcostal incision, possibly with midline extension.

Today the approach for open liver resections is the J incision, consisting in a right subcostal incision with midline extension.

Minimal invasive approach, consisting in laparoscopic and then robotic surgery, has become increasingly common in liver resective surgery.

Hepatectomies may be anatomic: the lines of resection match the limits of one or more functional segments of the liver, or they may be non-anatomic, irregular or “wedge” hepatectomies.

Anatomic resections are generally preferred because of the smaller risk of bleeding and biliary fistula; however, non-anatomic resections can be performed safely.

The intraoperative blood loss during liver resections affects the outcome in terms of postoperative morbidity and mortality.

Biliary fistula is a possible complication.

Pulmonary complications such as atelectasis and pleural effusion are commonplace.

Liver failure is the most serious complication of liver resection, and is a major deterrent in the surgical resection of hepatocellular carcinoma in patients with cirrhosis.

15 to 25% of patients receiving perioperative blood transfusions.

As with most major surgical procedures, there is a marked tendency towards optimal results at the hands of surgeons with high caseloads in selected centers.

Combination treatment with systemic or regionally infused chemo or biological therapy is also considered.

Prior to surgery, cytotoxic agents such as oxaliplatin given systemically for colorectal metastasis, or chemoembolization for hepatocellular carcinoma can significantly decrease the size of the tumor bulk, allowing then for resections which would remove a segment or wedge portion of the liver only.

These procedures can also be aided by application of liver clamp (Lin or Chu liver clamp; Pilling no.604113-61995) in order to minimize blood loss.[citation needed]

Tranexamic use does not reduce bleeding or blood transfusion, and increases postoperative complications.

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