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Concept
Hepatectomy
Summary
Hepatectomy is the surgical resection (removal of all or part) 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.
The first hepatectomies were reported by Dr. Ichio Honjo (1913–1987) of (Kyoto University) 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 which had metastasized to the liver.
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. 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. 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 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.
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Liver cancer
Liver cancer (also known as hepatic cancer, primary hepatic cancer, or primary hepatic malignancy) is cancer that starts in the liver. Liver cancer can be primary (starts in liver) or secondary (meaning cancer which has spread from elsewhere to the liver, known as liver metastasis). Liver metastasis is more common than that which starts in the liver. Liver cancer is increasing globally. Primary liver cancer is globally the sixth-most frequent cancer and the fourth-leading cause of death from cancer.
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. The development of HCC is attributed to fibrosis and cirrhosis, which occur in the setting of chronic liver injury and inflammation. The latter being closely linked to chronic viral hepatitis infection (hepatitis B or C) or exposure to toxins such as alcohol, aflatoxin, or pyrrolizidine alkaloids.