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Liver resection for benign and malignant conditions has evolved significantly over the past 2 decades. Moreover, considerable interest in the field of liver surgery has led to an increase in the number of surgeons subspecializing in hepatobiliary surgery. This interest has brought significant innovation and evolution to the field including new technologies in minimally invasive approaches, expanded indications for patients with liver metastases, and the ability to plan and perform more complex resections. At the same time, improvements in patient selection, liver function assessment, and perioperative care have significantly improved the safety of liver resection at experienced tertiary centers. The concepts and principles of liver surgery are expertly reviewed in Chapters 56 (Hepatic Abscess and Cystic Disease of the Liver) and 57 (Benign Liver Neoplasms). Herein, we provide a perspective on recent advances in the field of liver resection, their impact on patient outcomes, and where future developments are anticipated.


Indications for Resection

Although the majority of liver resections today are performed for malignant indications, hepatobiliary surgeons should be familiar with the management of benign conditions as well (Table 60-1). Benign simple cysts can typically be characterized with cross-sectional imaging and do not require resection unless they are symptomatic (unusual unless >10 cm) or contain features worrisome for biliary cystadenoma or cystadenocarcinoma. In the former (simple cyst), laparoscopic fenestration is the preferred treatment, whereas in the latter, formal resection or enucleation should be performed. One notable and frequent cause of liver cystic disease globally is echinococcal or hydatid cyst. Surgical resection of the cyst-bearing area of the liver or operative drainage of the cyst (to ensure prevention of spillage and potential anaphylactic shock) is occasionally required. Despite improvements in antimicrobial therapy and percutaneous aspiration and drainage techniques, the need for occasional surgical management of nonechinococcal hepatic abscesses remains. Finally, hepatic adenomas are benign tumors of the liver that have a low rate of malignant transformation and risk of rupture that increases with size, pregnancy, and location of the tumor. Most authors therefore recommend resection of lesions >5 cm or in women of childbearing age with tumors at risk for rupture. Hemangiomas and focal nodular hyperplasias are benign conditions that do not require resection (or surveillance) unless they are symptomatic, which, in general, is rare.



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