The changing face of hepatic resection

Abstract

Although the first surgical removal of a portion of the human liver was recorded more than two centuries ago, the liver was regarded as a noli me tangere (“do not touch me”) organ until the beginning of this century. This fear still exists in some degree even today. Until 10 to 15 years ago, the operative mortality with major hepatic resections was too great to justify their use if a less dangerous, even though unsatisfactory, alternative was available. This is no longer a supportable point of view in the 1980s. Major hepatic resections can now be performed quite safely, and indications for the operation have become far less restrictive for both malignant and benign hepatic lesions. Increased numbers of hepatic mass-lesions are found today by advanced imaging technology, and physicians and surgeons are asked frequently for their best management. Our main concerns in this monograph are to summarize the essential surgical anatomy of the liver, the basic surgical pathology, and the techniques of hepatic resection. We also report our experience with excisional therapy for benign and malignant hepatic lesions over the last 25 years.