Hepatobiliary Surgery: Indications, Evaluation, and Outcomes

  • Milan Kinkhabwala
  • Marcelo Vivanco


Complex surgical intervention for liver disease is a relatively new addition in medical practice. Early attempts at surgical resection were associated with high rates of total morbidity. Mirroring the experience in cardiac surgery, advances in physiology and anatomy, new technology, standardized surgical techniques, and improvements in perioperative management have all contributed to the current reliability and success associated with hepatic surgery. While hepatic surgery continues to be mostly performed in larger centers, hepatobiliary programs have proliferated so that access to high-quality liver surgical care is now available in virtually all major metropolitan areas in North America. Centers of excellence are generally characterized by a higher volume surgical procedures and a commitment to multidisciplinary specialty care. Hepatology, critical care medicine, interventional radiology, and diagnostic radiology are some of the core disciplines that are required to support a hepatobiliary program.


Hepatic Vein Hepatic Resection Transjugular Intrahepatic Portosystemic Shunt Portal Vein Embolization Remnant Liver 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Aloia TA, Fahy BN, Fischer CP, Jones SL, Duchini A, Galati J, et al. Predicting poor outcome following hepatectomy: analysis of 2313 hepatectomies in the NSQIP database. HPB (Oxford). 2009;11(6):510–5.CrossRefGoogle Scholar
  2. 2.
    Jarnagin W, Chapman WC, Curley S, D’Angelica M, Rosen C, Dixon E, et al. Surgical treatment of hepatocellular carcinoma: expert consensus statement. American Hepato-Pancreato-Biliary Association; Society of Surgical Oncology; Society for Surgery of the Alimentary Tract. HPB (Oxford). 2010;12(5):302–10. Review.Google Scholar
  3. 3.
    Sotiropoulos GC, Drühe N, Sgourakis G, Molmenti EP, Beckebaum S, Baba HA, et al. Liver transplantation, liver resection, and transarterial chemoembolization for hepatocellular carcinoma in cirrhosis: which is the best oncological approach? Dig Dis Sci. 2009;54(10):2264–73. Epub 2008 Dec 5.PubMedCrossRefGoogle Scholar
  4. 4.
    Bellavance EC, Lumpkins KM, Mentha G, Marques HP, Capussotti L, Pulitano C, et al. Surgical management of early-stage hepatocellular carcinoma: resection or transplantation? J Gastrointest Surg. 2008;12(10):1699–708. Epub 2008 Aug 15.PubMedCrossRefGoogle Scholar
  5. 5.
    Are C, Gonen M, Zazzali K, Dematteo RP, Jarnagin WR, Fong Y, et al. The impact of margins on outcome after hepatic resection for colorectal metastasis. Ann Surg. 2007;246(2):295–300.PubMedCrossRefGoogle Scholar
  6. 6.
    Mayo SC, Pawlik TM. Current management of colorectal hepatic metastasis. Expert Rev Gastroenterol Hepatol. 2009;3(2):131–44. Review.PubMedCrossRefGoogle Scholar
  7. 7.
    AASLD Practice Guidelines, AASLD online published July 2010 ( [Accessed Feb 2012]
  8. 8.
    Llovet JM, Ricci S, Mazzaferro V, et al. SHARP Investigators Study Group. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359(4):378–90.PubMedCrossRefGoogle Scholar
  9. 9.
    Claude C, Foie L. Etudes Anatomiques et Chirurgicales. Paris: Masson; 1957.Google Scholar
  10. 10.
    Cantlie J. On a new arrangement of the right and left lobes of the liver. Proc Anat Soc Great Britain Ireland. 1897;32:4–9.Google Scholar
  11. 11.
    Fondevila C, Hessheimer AJ, Taurá P, et al. Portal hyperperfusion: mechanism of injury and stimulus for regeneration in porcine small-for-size transplantation. Liver Transpl. 2010 Mar;16(3):364–74.CrossRefGoogle Scholar
  12. 12.
    Chan SC, Lo CM, Ng KK, Fan ST. Alleviating the burden of small-for-size graft in right liver living donor liver transplantation through accumulation of experience. Am J Transplant. 2010;10(4):859–67.PubMedCrossRefGoogle Scholar
  13. 13.
    de Baere T, Robinson JM, Deschamps F, Rao P, Teriitheau C, Goere D, et al. Preoperative portal vein embolization tailored to prepare the liver for complex resections: initial experience. Cardiovasc Intervent Radiol. 2010;33(5):976–82. Epub 2010 Jan 8.PubMedCrossRefGoogle Scholar
  14. 14.
    Okabe H, Beppu T, Ishiko T, Masuda T, Hayashi H, Otao R, Hasita H, Okabe K, Sugiyama S, Baba H. Preoperative portal vein embolization (PVE) for patients with hepatocellular carcinoma can improve resectability and may improve disease-free survival. J Surg Oncol. 2011;104(6):641–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Agrawal S, Belghiti J. Oncologic resection for malignant tumors of the liver. Ann Surg. 2011;253(4): 656–65.PubMedCrossRefGoogle Scholar
  16. 16.
    Cucchetti A, Ercolani G, Vivarelli M, Cescon M, Ravaioli M, Ramacciato G, Grazi GL, Pinna AD. Is portal hypertension a contraindication to hepatic resection? Ann Surg. 2009;250(6):922–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Simons JP, Ng SC, Hill JS, Shah SA, Zhou Z, Tseng JF. In-hospital mortality from liver resection for hepatocellular carcinoma: a simple risk score. Cancer. 2010;116(7):1733–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Schroeder RA, Marroquin CE, Bute BP, Khuri S, Henderson WG, Kuo PC. Predictive indices of morbidity and mortality after liver resection. Ann Surg. 2006;243(3):373–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Hsu KY, Chau GY, Lui WY, Tsay SH, King KL, Wu CW. Predicting morbidity and mortality after hepatic resection in patients with hepatocellular carcinoma: the role of Model for End-Stage Liver Disease score. World J Surg. 2009;33(11):2412–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Teh SH, Christein J, Donohue J, Que F, et al. Hepatic resection of hepatocellular carcinoma in patients with cirrhosis: Model of End-Stage Liver Disease (MELD) score predicts perioperative mortality. J Gastrointest Surg. 2005;9(9):1207–15. discussion 1215.PubMedCrossRefGoogle Scholar
  21. 21.
    Doberneck RC, Sterling Jr WA, Allison DC. Morbidity and mortality after operation in nonbleeding cirrhotic patients. Am J Surg. 1983;1146:306.CrossRefGoogle Scholar
  22. 22.
    Liddo G, Buc E, Nagarajan G, Hidaka M, Dokmak S, Belghiti J. The liver hanging manoeuvre. HPB (Oxford). 2009;11(4):296–305.CrossRefGoogle Scholar
  23. 23.
    Minami Y, Kudo M. Radiofrequency ablation of hepatocellular carcinoma: current status. World J Radiol. 2010;2(11):417–24.PubMedCrossRefGoogle Scholar
  24. 24.
    Ueno S, Sakoda M, Kubo F, Hiwatashi K, Tateno T, Baba Y, et al. Surgical resection versus radiofrequency ablation for small hepatocellular carcinomas within the Milan criteria. J Hepatobiliary Pancreat Surg. 2009;16(3):359–66. Epub 2009 Mar 20.PubMedCrossRefGoogle Scholar
  25. 25.
    Rodriguez J, Tellioglu G, Siperstein A, et al. Myoglobinuria after laparoscopic radiofrequency ablation of liver tumors. J Gastrointest Surg. 2010;14(4):664–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Gagner M, Rogula T, Selzer D. Laparoscopic liver resection: benefits and controversies. Surg Clin North Am. 2004;84:451–62.PubMedCrossRefGoogle Scholar
  27. 27.
    Dagher I, O’Rourke N, Geller DA, et al. Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg. 2009;250:856–60.PubMedCrossRefGoogle Scholar
  28. 28.
    Koffron A, Geller D, Gamblin TC, et al. Laparoscopic liver surgery: shifting the management of liver tumors. Hepatology. 2006;44(6):1694–700.PubMedCrossRefGoogle Scholar
  29. 29.
    Kazaryan AM, Marangos IP, Røsok BI, Rosseland AR, Villanger O, Fosse E, et al. Laparoscopic resection of colorectal liver metastases: surgical and long-term oncologic outcome. Ann Surg. 2010;252(6): 1005–12.PubMedCrossRefGoogle Scholar
  30. 30.
    Nguyen KT, Gamblin CT, Geller DA. World review of laparoscopic liver resection—2,804 patients. Ann Surg. 2009;250(5):831–41.PubMedCrossRefGoogle Scholar
  31. 31.
    Buell J, Cherqui D, Geller D, et al. The Louisville statement on laparoscopic liver surgery. Ann Surg. 2009;250(5):825–30.PubMedCrossRefGoogle Scholar
  32. 32.
    Vibert E, Adam R. High intra-abdominal pressure during experimental laparoscopic liver resection reduces bleeding but increases the risk of gas embolism. Br J Surg. 2011;98(6):845–52.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.Montefiore Medical Center, Medical Arts PavilionNew YorkUSA
  2. 2.Department of SurgeryMontefiore Medical CenterBronxUSA

Personalised recommendations