Liver resection in Cirrhotic liver: Are there any limits?

Abstract

Liver resection remains one of the most technically challenging surgical procedure in abdominal surgery due to the complex anatomical arrangement in the liver and its rich blood supply that constitutes about 20% of the cardiac output per cycle. The challenge for resection in cirrhotic livers is even higher because of the impact of surgical stress and trauma imposed on borderline liver function and the impaired ability for liver regeneration in cirrhotic livers. Nonetheless, evolution and advancement in surgical techniques as well as knowledge in perioperative management of liver resection has led to a substantial improvement in surgical outcome in recent decade. The objective of this article was to provide updated information on the recent developments in liver surgery, from preoperative evaluation, to technicality of resection, future liver remnant augmentation and finally, postoperative management of complications.

Keywords: ALPPS; Associating liver partition and portal vein ligation for staged heaptectomy; Bile leakage; Cirrhosis; Hepatectomy; Hepatocellular carcinoma; ICG; Liver failure; Liver resection; Portal vein embolization; Robotic liver surgery; Volumetry.