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Ebook Master techniques in general surgery - Hepatobiliary and pancreatic surgery: Part 2

(BQ) Part 2 book "Master techniques in general surgery - Hepatobiliary and pancreatic surgery" presentation of content: Right and extended right hepatectomy, left and extended left hepatectomy, central hepatectomy, hepatic caudate resection, enucleation of hepatic lesions, hepatic segmental resections,. and other contents. | 18 Hepatic Resection: General Considerations Jean-Nicolas Vauthey and Junichi Shindoh Introduction Resection is the first-line treatment in selected patients with primary or metastatic hepatic malignancies. In recent decades, refinements in surgical techniques and in perioperative patient care have improved the safety of liver resection; however, the most important factor influencing outcomes after liver resection is the surgeon's knowledge of the basic surgical principles pertaining to the procedure. Postoperative morbidity and mortality rates can be reduced by proper patient selection, attention to liver anatomy and volumetry, and use of the optimal approach and technique for resection. At largevolume centers, the 90-day mortality rates after liver resection are now less than 5%, and the rate of complete resections with negative margins is approaching 90%. These rates are not likely to be substantially further improved, especially as the limits of resectability are continually being pushed; therefore low morbidity rates and early recovery will have to be considered as the new primary endpoints. In this chapter, we report the general principles pertaining to the safe and complete resection of liver tumors. Preoperative Assessment In recent years, the eligibility criteria for liver resection have been expanded to include patients not previously deemed to be surgical candidates, such as those with multiple bilobar liver metastases from colorectal cancer and those with large or multinodular hepatocellular carcinoma (HCC). However, the current definition of resectability still requires that the surgeon be able to completely remove the tumor while preserving a sufficient remnant of healthy liver tissue to limit the risk of postoperative liver dysfunction. This oncosurgical definition necessitates attention to (1) the extent of the tumor and (2) the quality and volume of the anticipated remnant liver after negative margins are achieved. Evaluating Tumor Extent In .