Medicine:Hepatectomy

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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.

History

The first hepatectomies were reported by Dr. Ichio Honjo (1913–1987) of (Kyoto University) in 1949,[1] and Dr. Jean-Louis Lortat-Jacob (1908–1992) of France in 1952.[2] In the latter case, the patient was a 58-year-old woman diagnosed with colorectal cancer 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. 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.[3]

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.[4] The anterior approach, one of the most innovative, is made simpler by the liver hanging maneuver.[5] 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 classification (cf. liver#Functional anatomy);[6] 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.[7]


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 morbidity and mortality.[8] Biliary 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.

Results

Etymology

See also

References

  1. ↑ Tsuchiya, Ryoichi (2002). "我が国の肝膵外科学 : 1.本庄一夫記念シンポジウムによせて(<特集>創造と調和" (in ja). Nihon Geka Gakkai Zasshi 103 (3): 318–21. PMID 11968765. http://ci.nii.ac.jp/naid/110003944883. 
  2. ↑ Lortat-Jacob, JL; Robert, HG (1952). "Hépatectomie droite réglée" (in fr). La Presse Médicale 60 (26): 549–51. PMID 14948909. 
  3. ↑ Kumar, Vinay, ed (2021). Robbins & Cotran pathologic basis of disease (10th ed.). Philadelphia, PA: Elsevier. pp. 104. ISBN 978-0-323-53113-9. OCLC on1191840836. https://www.worldcat.org/title/on1191840836. 
  4. ↑ Chang, SB; Palavecino, M; Wray, CJ; Kishi, Y; Pisters, PW; Vauthey, JN (March 2010). "Modified Makuuchi incision for foregut procedures.". Archives of Surgery 145 (3): 281–4. doi:10.1001/archsurg.2010.7. PMID 20231630. 
  5. ↑ Liddo, Guido; Buc, Emmanuel; Nagarajan, Ganesh; Hidaka, Masaaki; Dokmak, Safi; Belghiti, Jacques (2009). "The liver hanging manoeuvre". HPB 11 (4): 296–305. doi:10.1111/j.1477-2574.2009.00068.x. PMID 19718356. 
  6. ↑ Knipe, Henry; Jones, Jeremy. "Couinaud classification". UBM Medica Network. http://radiopaedia.org/articles/couinaud-classification. 
  7. ↑ International Hepato-Pancreatico-Biliary Association (IHPBA) Terminology for Liver Resections
  8. ↑ Jarnagin, WR; Gonen, M; Fong, Y; DeMatteo, RP; Ben-Porat, L; Little, S; Corvera, C; Weber, S et al. (October 2002). "Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade.". Annals of Surgery 236 (4): 397-406; discussion 406-7. doi:10.1097/01.SLA.0000029003.66466.B3. PMID 12368667. 



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