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Current technical aspects of oncological hepatic surgery

摘要BACKGROUND: With the recent advances in oncological he-patic surgery, major liver resections became more widely uti-lized procedures. The era of modern hepatic surgery witnessed improvements in patients care in preoperative, intraoperative and postoperative aspects. This significantly improved surgi-cal outcomes regarding morbidity and mortality. This review article focuses on the recent advances in oncological hepatic surgery.DATA SOURCES: This review includes only data from peer-re-viewed articles and journals. PubMed database was utilized as the primary source of the supporting literature to this review article on the latest advances in oncological hepatic surgery. Comprehensive and high sensitivity search strategies were performed to search related studies exhaustively up till June 2016. We critically and independently assessed over 50 recent publications written on this topic according to the selection criteria and quality assessment standard. We paid particular attention to the studies published in high impact journals that address the use of the surgical techniques mentioned in the articles in well-known institutions.RESULTS: Among all utilized approaches aiming at the pre-operative assessment of the liver function, Child-Turcotte-Pugh classification remains the most reliable tool correlating with survival outcome. Although the primary radiological tools including ultrasonography, computed tomography and magnetic resonance imaging remain on top of the menu of tests utilized in assessment of focal hepatic lesions, intraop-erative ultrasonography projects to be a powerful additional tool in terms of sensitivity and specificity compared to the other conventional techniques in assessment of the liver in the operative setting, a procedure that can change the surgical strategy in 27.2% of the cases and consequently improve the oncological surgical outcome. In addition to the conventional surgical techniques of liver resection and portal vein embo-lization, associating liver partition and portal vein ligation for staged hepatectomy "ALPPS" projects to be an alternative option in patients with marginally resectable tumors with an inadequate size of future liver remnant with an accepted sur-gical oncological outcome.CONCLUSIONS: Considering the clinicopathological nature of hepatic lesions, the comprehensive assessment and proper choice of the liver resection technique in highly selected pa-tients is associated with improved surgical oncological out-come. Patients with underlying marginal future liver remnant volumes can now safely benefit from a wider range of surgical intervention, a breakthrough that significantly improved morbidity and mortality in this group of patients.

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作者单位 Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue BX7375 CLINICAL SCIENCE CNTR Madison, WI 53792-7375, USA [1]
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DOI 10.1016/S1499-3872(16)60147-9
发布时间 2017-04-21(万方平台首次上网日期,不代表论文的发表时间)
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国际肝胆胰疾病杂志(英文版)

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