Early experiences in liver resection: lesson learned from liver surgery and transplantation fellowship program and its implementation in daily surgical practice

Abstract

Introduction: Fellowship program in liver surgery and transplantation provide wide opportunities to learn and experience in all aspects of liver resection and transplantation, including patient selections and perioperative care. With extensive exposures in daily surgical practice of liver surgery, it is expected that fellow will be able to bring such expertise to his or her daily practices. After completion of fellowship, despite several limitations in diagnostic and therapeutic resources, we managed to start liver program and perform a series of liver resections with reasonable outcomes. Methods: From May 2016 to 2017, fourteen liver resections were performed, all of which were reviewed in this study. Results: There were 8 male and 6 female, with median age of 63 (range 17-74) years old. The indication of hepatectomy includes 8 primary liver cancers, 5 liver metastases (3 colorectal cancer, 2 renal cell carcinoma) and 1 liver trauma. There were 6 non anatomical resections and 9 anatomical resections, including Right hemihepatectomy, Left Hemihepatectomy, Left lateral sectionectomy, Right Posterior sectionectomy and Right Anterior sectionectomy. Inflow occlusion technique, either Glissionean approach or selective individual occlusion, together with Kelly crushing technique for parenchymal transection was applied in all cases. Conclusion: In limited resources setting like ours, a safe liver resection can still be done with a proper patient selection and adherent to basic principles such as understanding of individual anatomy with comprehensive imaging, good perioperative care and meticulous surgical technique, as have been learned from the fellowship days.