CHAPTER 13 Hepatectomy


Although once associated with significant morbidity and high mortality rates, improvements in surgical technique, anesthetic management, and postoperative care have made liver resection a viable treatment option for a variety of benign and malignant processes. At centers specializing in hepatobiliary surgery, overall mortality and morbidity rates are now estimated at 1% to 5% and 30% to 40%, respectively.

A variety of liver resections are commonly performed, including limited resections (e.g., tumor enucleation or wedge resection) and anatomic resections (i.e., removal of a segment or lobe of the liver). The extent of hepatic resection undertaken is, in part, dictated by the type of pathology and its anatomic location. Additionally, the choice of operation depends on the patient’s hepatic reserve. Up to 80% of the liver parenchyma can be removed from a normal liver because the remaining segment will hypertrophy and hepatic function will be restored within days to weeks. In the presence of underlying liver disease, however, significantly less liver parenchyma can be safely removed. The Child’s classification and its modifications are commonly used to assess a patient’s hepatic functional reserve (Table 13-1). In patients classified as Child’s class C, hepatic resection should not be attempted because of the very high risk of postoperative liver failure. Even in patients with well-compensated cirrhosis who are classified as Child’s class A, only limited hepatic resection should be performed.


There are three primary indications for partial hepatectomy in adults: neoplasm, infection, and to provide a liver lobe for transplantation.

I. Neoplasm: The majority of liver resections in the United States are performed for malignant disease, most commonly for metastatic cancer. Additionally, the increasing burden of hepatocellular carcinoma (HCC) in the United States because of chronic hepatitis C virus infection and cirrhosis has made liver resection and transplantation for HCC more common. In contrast, hepatic resection for cholangiocarcinoma remains relatively uncommon because the majority of patients with this malignancy present with advanced, unresectable disease.
A. Malignant Neoplasms

May 26, 2018 | Posted by in GENERAL SURGERY | Comments Off on Hepatectomy

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