Hepatectomy

Hepatectomy

Interventions infobox
Name = PAGENAME


Caption =
ICD10 =
ICD9 = 50.22
ICD9_mult = ICD9proc|50.4
MeshID = D006498
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Hepatectomy consists on the surgical resection of the liver. While the term is often employed for the removal of the liver from a liver transplant recipient, this article will focus on partial resections of hepatic tissue.

History

The first successful anatomic hepatectomy was reported by Jean-Louis Lortat-Jacob in 1952, the patient being 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 malignant.

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.

Hepatectomy may also be the procedure of choice to treat intrahepatic gallstones or parasitic cysts of the liver.

Technique

Access is accomplished by laparotomy, typically by a bilateral subcostal ("chevron") incision, possibly with midline extension (Calne or "Mercedes-Benz" incision).

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); 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.For details on the variety of anatomic hepatectomies and the specific nomenclature, cf. the [http://www.ihpba.org/html/guidelines/index.html International Hepato-Pancreatico-Biliary Association (IHPBA) Terminology for Liver Resections]

Complications

Bleeding is the most feared technical complication and may be grounds for urgent reoperation. 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.

Liver failure poses a significant hazard to patients with underlying hepatic disease; 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).

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.

References


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Look at other dictionaries:

  • hepatectomy — [hep΄ə tek′tə mē] n. pl. hepatectomies [ HEPAT(O) + ECTOMY] the surgical removal of part or all of the liver …   English World dictionary

  • hepatectomy — Removal of the liver, whole or in part. [hepat + G. ektome, excision] * * * hep·a·tec·to·my .hep ə tek tə mē n, pl mies excision of the liver or of part of the liver hep·a·tec·to·mized also Brit hep·a·tec·to·mised tə .mīzd adj * * * n. the …   Medical dictionary

  • hepatectomy — n. the operation of removing the liver. Partial hepatectomy is the removal of one or more lobes of the liver; it may be carried out after severe injury or to remove a tumour localized in one part of the liver …   The new mediacal dictionary

  • hepatectomy — noun (plural mies) Date: circa 1890 excision of the liver or of part of the liver • hepatectomized adjective …   New Collegiate Dictionary

  • hepatectomy — /hep euh tek teuh mee/, n., pl. hepatectomies. excision of part of the liver. [1895 1900; HEPAT + ECTOMY] * * * …   Universalium

  • hepatectomy — noun The surgical removal of all or part of the liver …   Wiktionary

  • hepatectomy — n. surgical removal of all or part of the liver …   English contemporary dictionary

  • hepatectomy — hep·a·tec·to·my …   English syllables

  • hepatectomy — hep•a•tec•to•my [[t]ˌhɛp əˈtɛk tə mi[/t]] n. pl. mies srg the surgical excision of part or all of the liver • Etymology: 1895–1900 …   From formal English to slang

  • hepatectomy — Surgery to remove all or part of the liver …   English dictionary of cancer terms

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