Innovative Strategies and Recent Advances in Liver Surgery

Techniques for hepatic surgery have evolved over the past few decades and have broadened indications for liver resection (LR) for liver tumors. New strategies including downsizing chemotherapy, two-stage LR with or without portal vein embolization, and resection combined with ablative methods allow tailoring the treatment to each patient depending on condition of the liver and tumor burden. In the recent years, the new dissector devices have been developed and together with the use of intraoperative ultrasound allow a new approach to the anatomical ultrasound-guided liver resection, even for large tumors located in challenging positions. Improvements in imaging evaluation with high-resolution CT scan or MRI allow new methods for the study of the future remnant liver and play an important role in the planning of the resection strategy reducing the risk of major complications and liver failure, especially in patients who undergo major resection. In addition, development of new technology in local ablative therapies for liver tumors is posing a competition to LR. The incidence of hepatocellular carcinoma (HCC) is climbing rapidly and in a current climate of organ shortage has led to the re-evaluation of locoregional therapies and resectional surgery to manage the case load. The introduction of biological therapies has had a new dimension to care, adding to the complexities of multidisciplinary team working in the management of HCC. S. E. Khorsandi and N. Heaton give a very comprehensive overview of the present day management strategies and decision making for patients with HCC. Simultaneous resection of primary colorectal carcinoma (CRC) and synchronous liver metastases (SLM) is subject of debate with respect to morbidity in comparison to staged resection. In contrast to the extensive literature on staged laparoscopic colorectal and laparoscopic liver surgery, there are only a few reports on combined laparoscopic colorectal and liver resection. L. T. Hoekstra and colleagues report their initial experience of simultaneous laparoscopic resection of primary CRC and SLM. According to the modern literature, the authors conclude that patient selection and expertise are essential for this complex type of surgery and the multidisciplinary team should decide on optimal timing within multimodality schedules. I. Popescu and S. T. Alexandrescu challenge recent evidence in the different surgical options for initially unre-sectable colorectal liver metastases. The authors illustrate the available oncosurgical modalities including liver resection following portal vein ligation/embolization, " two-stage " liver resection, one-stage ultrasonically guided liver resection, hepatectomy following conversion chemotherapy, and liver resection combined with …