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,[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.[citation needed]
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.[citation needed]
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.[3] The anterior approach, one of the most innovative, is made simpler by the liver hanging maneuver.[4] 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);[5] 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.[6]
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.[7]Biliaryfistula 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.[citation needed]
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 metastases).[citation needed]
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).[citation needed]
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.[citation needed]
Etymology
The word "hepatectomy" is derived from Greek. In Greek liver is hepar and -ectomy comes from the Greek ektomē, "to remove."[citation needed]
^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" [Surgery of the liver and pancreas in Japan--message to the special symposium commemorating Dr. Ichio Honjo]. Nihon Geka Gakkai Zasshi (in Japanese). 103 (3): 318–21. PMID 11968765.
^Lortat-Jacob, JL; Robert, HG (1952). "Hépatectomie droite réglée" [Well defined technique for right hepatectomy]. La Presse Médicale (in French). 60 (26): 549–51. PMID 14948909.
^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.
^International Hepato-Pancreatico-Biliary Association (IHPBA) Terminology for Liver Resections
^Jarnagin, WR; Gonen, M; Fong, Y; DeMatteo, RP; Ben-Porat, L; Little, S; Corvera, C; Weber, S; Blumgart, LH (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 (inactive 31 December 2022). PMC1422593. PMID 12368667.{{cite journal}}: CS1 maint: DOI inactive as of December 2022 (link)
External links
Oncolex, the cancer encyclopedia, on liver cancer
The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery – Video of Extended Left Hepatectomy procedure
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
January 05, 2023
hepatectomy, surgical, resection, removal, part, liver, while, term, often, employed, removal, liver, from, liver, transplant, donor, this, article, will, focus, partial, resections, hepatic, tissue, hepatoportoenterostomy, cm50, 4meshd006498, edit, wikidata, . 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 HepatectomyICD 9 CM50 22 50 4MeSHD006498 edit on Wikidata Contents 1 History 2 Indications 3 Technique 4 Complications 5 Results 6 Etymology 7 See also 8 References 9 External linksHistory EditThe 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 citation needed Indications EditMost 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 citation needed Technique EditA 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 3 The anterior approach one of the most innovative is made simpler by the liver hanging maneuver 4 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 5 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 6 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 citation needed Complications EditBleeding 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 7 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 citation needed 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 metastases citation needed Results EditLiver 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 citation needed 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 citation needed Etymology EditThe word hepatectomy is derived from Greek In Greek liver is hepar and ectomy comes from the Greek ektome to remove citation needed See also EditList of surgeries by typeReferences Edit Scholia has a profile for hepatectomy Q1514021 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 lt 特集 gt 創造と調和 Surgery of the liver and pancreas in Japan message to the special symposium commemorating Dr Ichio Honjo Nihon Geka Gakkai Zasshi in Japanese 103 3 318 21 PMID 11968765 Lortat Jacob JL Robert HG 1952 Hepatectomie droite reglee Well defined technique for right hepatectomy La Presse Medicale in French 60 26 549 51 PMID 14948909 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 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 PMC 2727082 PMID 19718356 Knipe Henry Jones Jeremy Couinaud classification UBM Medica Network Retrieved 2 December 2014 International Hepato Pancreatico Biliary Association IHPBA Terminology for Liver Resections Jarnagin WR Gonen M Fong Y DeMatteo RP Ben Porat L Little S Corvera C Weber S Blumgart LH 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 inactive 31 December 2022 PMC 1422593 PMID 12368667 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint DOI inactive as of December 2022 link External links EditOncolex the cancer encyclopedia on liver cancer Video showing laprascopic liver resection The Toronto Video Atlas of Liver Pancreas and Transplant Surgery Video of Extended Left Hepatectomy procedure 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 The Toronto Video Atlas of Liver Pancreas and Transplant Surgery Video of Laparoscopic Right Hepatectomy procedure Retrieved from https en wikipedia org w index php title Hepatectomy amp oldid 1130885598, wikipedia, 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