Hepatectomy

Until several years ago, surgical removal of a part of the liver (hepatectomy) used to be prohibitive because of the very significant complications that it was associated with. Today, hepatectomy is very safe and efficacious because surgical technology has dramatically advanced and operative techniques have drastically excelled. Provided that there is no underlying liver disease (cirrhosis), up to 60% of the liver can be safely removed without any consequences to the patient whatsoever. Modern resection techniques include the Cavitron Ultra Sonic Aspirator (CUSA), Radiofrequency ablation probes. These and others allow for essentially bloodless liver resections. We always perform intraoperative ultrasonography. This is by far the most accurate imaging modality for liver lesions; it can demonstrate the exact location and number of metastatic nodules with the highest possible precision, which exceeds MRI or CT. It is essential when removing metastases from the liver to do so with healthy margins. This means that a rim of healthy liver tissue should surround the metastatic nodule from all sides. When hepatectomy is performed expertly, possibly in combination with other aggressive modalities (when appropriate), offers the only realistic chance for long-term cure and survival.