Total hepatectomy
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Hepatectomy is the surgical resection (removal of all or part) of the
liver The liver is a major Organ (anatomy), organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of proteins and biochemicals necessary for ...
. While the term is often employed for the removal of the liver from a
liver transplant Liver transplantation or hepatic transplantation is the replacement of a Liver disease, diseased liver with the healthy liver from another person (allograft). Liver transplantation is a treatment option for Cirrhosis, end-stage liver disease and ...
donor, this article will focus on partial resections of hepatic tissue and hepatoportoenterostomy.


History

The first hepatectomies were reported by Dr. Ichio Honjo (1913–1987) of (
Kyoto University , mottoeng = Freedom of academic culture , established = , type = National university, Public (National) , endowment = ¥ 316 billion (2.4 1000000000 (number), billion USD) , faculty = 3,480 (Teaching Staff) , administrative_staff ...
) in 1949, and Dr. Jean-Louis Lortat-Jacob (1908–1992) of France in 1952. In the latter case, the patient was a 58-year-old woman diagnosed with
colorectal cancer Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer from the colon or rectum (parts of the large intestine). Signs and symptoms may include blood in the stool, a change in bowel m ...
which had metastasized to the liver.


Indications

Most hepatectomies are performed for the treatment of hepatic neoplasms, both benign or malign. Benign neoplasms include hepatocellular adenoma, hepatic hemangioma and
focal nodular hyperplasia Focal nodular hyperplasia (FNH) is a benign tumor of the liver ( hepatic tumor), which is the second most prevalent tumor of the liver (the first is hepatic hemangioma). It is usually asymptomatic, rarely grows or bleeds, and has no malignant pot ...
. The most common malignant neoplasms (cancers) of the liver are metastases; those arising from colorectal cancer are among the most common, and the most amenable to surgical resection. The most common primary malignant tumour of the liver is the
hepatocellular carcinoma Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer in adults and is currently the most common cause of death in people with cirrhosis. HCC is the third leading cause of cancer-related deaths worldwide. It occurs in t ...
. Another primary malignant liver tumor is the
cholangiocarcinoma Cholangiocarcinoma, also known as bile duct cancer, is a type of cancer that forms in the bile ducts. Symptoms of cholangiocarcinoma may include abdominal pain, yellowish skin, weight loss, generalized itching, and fever. Light colored stool ...
. 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.


Technique

A hepatectomy is considered a major surgical procedure performed under general anesthesia. Access is accomplished by laparotomy, historically by a bilateral subcostal ("chevron") incision, possibly with midline extension (Calne or "Mercedes-Benz" incision). Nowadays a broadly used approach for open liver resections is the J incision, consisting in a right subcostal incision with midline extension. The anterior approach, one of the most innovative, is made simpler by the liver hanging maneuver. In most recent years the minimal invasive approach, consisting in laparoscopic and then robotic surgery, has become increasingly common in liver resective surgery. Hepatectomies may be anatomic, i.e. the lines of resection match the limits of one or more functional segments of the liver as defined by the
Couinaud Claude Couinaud (12 February 1922, in Neuilly-sur-Seine – 4 May 2008, in Paris) was a French surgeon and anatomist who made significant contributions in the field of hepatobiliary The biliary tract, (biliary tree or biliary system) refers ...
classification (cf. liver#Functional anatomy); 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 as well in selected cases. The Pringle manoeuvre is usually performed during a hepatectomy to minimize blood loss - however this can lead to reperfusion injury in the liver due to
Ischemia Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems wi ...
.


Complications

Bleeding is a feared technical complication and may be grounds for urgent reoperation. It has been demonstrated that the intraoperative blood loss during liver resections affects the outcome in terms of postoperative morbility and mortality.
Biliary A bile duct is any of a number of long tube-like structures that carry bile, and is present in most vertebrates. Bile is required for the digestion of food and is secreted by the liver into passages that carry bile toward the hepatic duct. It ...
fistula is also a possible complication, albeit one more amenable to nonsurgical management. Pulmonary complications such as atelectasis and pleural effusion are commonplace, and dangerous in patients with underlying lung disease. Infection is relatively rare. Liver failure is the most serious complication of liver resection; this is a major deterrent in the surgical resection of hepatocellular carcinoma in patients with cirrhosis. It is also a problem, to a lesser degree, in patients with previous hepatectomies (e.g. repeat resections for reincident
colorectal cancer Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer from the colon or rectum (parts of the large intestine). Signs and symptoms may include blood in the stool, a change in bowel m ...
metastases).


Results

Liver surgery is safe when performed by experienced surgeons with appropriate technological and institutional support. As with most major surgical procedures, there is a marked tendency towards optimal results at the hands of surgeons with high caseloads in selected centres (typically cancer centres and transplantation centres). For optimal results, combination treatment with systemic or regionally infused chemo or biological therapy should be 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.


Etymology

The word "hepatectomy" is derived from Greek. In Greek liver is ''hepar'' and -ectomy comes from the Greek ''ektomē'', "to remove."


See also

* List of surgeries by type


References


External links


Oncolex, the cancer encyclopedia, on liver cancer

Video showing laprascopic liver resection.


* [http://www.pie.med.utoronto.ca/tvasurg/TVASurg_content/surg/PL_standardLeftHepatectomy.html The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery – Video of Standard Left Hepatectomy procedure]
The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery – Video of Standard Right Hepatectomy procedure


{{Authority control Surgical oncology Hepatology Accessory digestive gland surgery