Liver resection for cancer

Recent reports have highlighted consistently improved perioperative morbidity and mortality rates following hepatic resection. Operative mortality rates, even in cirrhotic patients, are less than 5% in most recent series. The commonest indication for hepatic resection is primary or secondary hepatic malignancy and therefore appropriate preoperative assessment of such tumours is vitally important. Accurate radiological imaging, including the use of three-dimensional reconstruction, will indicate if lesions are resectable and will aid the decision regarding the likely surgical procedure. Portal vein embolisation is becoming a more widely accepted technique to induce contralateral hypertrophy reducing the risk of postoperative hepatic impairment and therefore increasing the indications for liver resection. The selection and subsequent management of patients with primary and secondary hepatic malignancy requires a multidisciplinary team approach involving hepatologists, radiologists, anaesthetists and surgeons and therefore the care of such patients should be undertaken in specialist hepatobiliary centres. Whilst accepting that hepatic resection offers the only prospect of cure for many patients, it is evident that future efforts will also be focused on determining the role of adjuvant treatments to reduce the inevitable recurrence of tumour which occurs in the majority of patients.