RT Book, Section
A1 Ellison, E. Christopher
A1 Zollinger, Robert M.
SR Print(0)
ID 1127273459
T1 RIGHT HEPATECTOMY (SEGMENTS 5, 6, 7, 8 ± SEGMENT 1)
T2 Zollinger's Atlas of Surgical Operations, 10e
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-179755-9
LK accesssurgery.mhmedical.com/content.aspx?aid=1127273459
RD 2024/04/20
AB The  successful  local  excision  of  benign  liver  tumors  has  fostered  a  more  aggressive  surgical  approach  to  the  excision  of  hepatic  metastases  of  colorectal  malignancies.  During  the  first  2  or  more  years  after  the  removal  of  a  colorectal  tumor,  carcinoembryonic  antigen  (CEA)  levels  are  measured  every  3  months.  When  the  CEA  level  begins  to  rise,  recurrence  must  be  considered.  In  the  absence  of  proof  of  metastasis  or  recurrence  in  the  rectum,  colon,  lung,  or  peritoneal  cavity,  a  search  is  made  for  hepatic  metastases.  Imaging  by  CT,  MRI,  or  PET  scans  is  performed.  Hepatic  angiography  is  usually  not  necessary  and  has  been  replaced  by  CT  or  MRI  with  coronal  reconstruction  to  define  regional  anatomy.  Any  evidence  of  liver  metastases  requires  an  evaluation  of  the  number,  size,  and  location  of  the  metastases.  It  is  hoped  that  none  or  only  one  or  two  solitary  metastases  will  be  verified  in  locations  easily  accessible  to  the  surgeon.  The  age  and  general  condition  of  the  patient,  as  well  as  the  size,  number,  and  locations  of  metastases,  are  considered  in  making  a  decision  to  attempt  curative  resection.  Given  the  sensitivity  of  modern  imaging,  “blind”  abdominal  exploration  for  rising  CEA  in  the  absence  of  radiographic  abnormalities  is  discouraged.  The  patient  should  be  fully  informed  and  should  participate  in  making  a  decision  to  re-operate.  The  patient  should  be  made  aware  that  a  major  portion  of  the  liver  may  need  to  be  excised.  A  residual  of  20%  or  more  of  normal  liver  tissue  remaining  in  the  left  lobe  is  essential  for  survival  but  this  number  may  exceed  30%  if  heavily  pretreated  with  chemotherapy.