Hepatic Resection
Selection criteria for Resection:
- Size of liver lesions: 5cm
- number of lesions : < 5 v/s >5
- distribution of lesions: uni v/s bi lobar
- Vol. of residual liver: adequate / <30%
Grey zone for resectability:
Resectable liver met in presence of:
- Extrahepatic disease: e.g in colorectal Carcinoma
- Resectable Pulmonary metastasis
- Adenocarcinoma with muscular invasion
- Hepatic hilar LN
R0 resection not possible:
- resection margin <1cm
- cytoreduction: NET
- Asymptomatic unknown / uncontrolled primary
Other selection criteria for Resection:based on Predictive factors for outcome:
- time from primary tumor to metastases
- tumor Grade
- nodal status of primary
- CEA levels
- number of liver lesions
- size of liver lesions
- resection margin status
- The volume of the liver remaining after resection (i.e., the future liver remnant) must be adequate.
- 20% of the total estimated liver volume for normal parenchyma:,
- 30%–60% if the liver is injured by chemotherapy, steatosis, or hepatitis
- 40%–70% in the presence of cirrhosis,
- Depending on the degree of underlying hepatic dysfunction increase/preserve hepatic reserve,
- Portal Vein Embolisation: inadequate FLR
- Two- stage resection: bilobar disease
- Combined local therapy: Resection Plus RFA
- Resect- larger lesion
- Ablate- smaller lesions
Decrease tumor size: Chemotherapy
- Indication: unresectable bilobar disease due to inadeuate FLR
- First stage: resect Mets in FLR,PVE,2nd Stage resection after 3-4weeks
- Patients with solitary hepatic metastases without clinical or radiographic evidence of additional tumor involvement is treated with partial liver resection.
- Hepatic resection is done in hydatid disease of liver If surgical cystectomy with removal of the germinal laminated layers is not technically feasible, then liver resection can be employed
Exam Important
- Adenocarcinoma with invasion of muscular layer is treated with Wedge hepatic resection with lymph node dissection
- Patients with solitary hepatic metastases without clinical or radiographic evidence of additional tumor involvement is treated with partial liver resection.
- Hepatic resection is done in hydatid disease of liver
- The minimum amount of normal perfused liver parenchyma to be left intact when a hepatic resection is planned is 20%
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