Skip to main content
SpringerLink
Log in

Surgical Considerations

  • Chapter
  • First Online:
Radiation Therapy for Liver Tumors

  • 1065 Accesses

Abstract

Surgery remains the mainstay of treatment for liver tumors. Liver resection is the treatment of choice for the management of primary liver tumors and liver metastases in suitable patients, if technically feasible and oncologically appropriate. Multiple lesions in both sides of the liver can be treated with surgical resection as long as the remnant liver has sufficient functional liver parenchyma with an intact hepatic arterial and portal venous inflow, venous outflow, and biliary drainage in continuity with the small bowel. Resection of multiple lesions has favorable long-term outcomes in patients with metastatic colorectal cancer. However, for other tumors, such as primary liver cancers, resection of multiple lesions is associated with poor long-term prognosis and is therefore rarely indicated even if technically feasible. Postoperative liver failure is associated with high risk of death after liver surgery and is most commonly seen in patients with cirrhosis. Therefore, surgical resection is limited to cirrhotic patients with Child-Turcotte-Pugh class A and no evidence of significant portal hypertension. The volume of the future liver remnant (FLR) needed to minimize the chances of postoperative liver insufficiency is dependent on the liver function. For patients with no liver dysfunction, the FLR should be at least 20% of the total liver volume. Patients with abnormal background liver should have a FLR of at least 30%, the total liver volume while those with cirrhosis should have a FLR of at least 40%. In patients with insufficient FLR, preoperative portal vein embolization to the hemiliver planned for resection can be performed in order to induce contralateral hypertrophy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236:397–407.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Karagkounis G, Seicean A, Berber E. The impact of laparoscopic approaches on short-term outcomes in patients undergoing liver surgery for metastatic tumors. Surg Laparosc Endosc Percutaneous Tech. 2015;25:229–34.

    Article  Google Scholar 

  3. Dixon E, Abdalla E, Schwarz RE, Vauthey JN. AHPBA/SSO/SSAT sponsored consensus conference on multidisciplinary treatment of hepatocellular carcinoma. HPB Official J Int Hepato Pancreato Biliary Assoc. 2010;12:287–8.

    Google Scholar 

  4. Schwarz RE, Abdalla EK, Aloia TA, Vauthey JN. AHPBA/SSO/SSAT sponsored consensus conference on the multidisciplinary treatment of colorectal cancer metastases. HPB Official J Int Hepato Pancreato Biliary Assoc. 2013;15:89–90.

    Article  Google Scholar 

  5. Pulitano C, Bodingbauer M, Aldrighetti L, et al. Liver resection for colorectal metastases in presence of extrahepatic disease: results from an international multi-institutional analysis. Ann Surg Oncol. 2011;18:1380–8.

    Article  PubMed  Google Scholar 

  6. Zech CJ, Korpraphong P, Huppertz A, et al. Randomized multicentre trial of gadoxetic acid-enhanced MRI versus conventional MRI or CT in the staging of colorectal cancer liver metastases. Br J Surg. 2014;101:613–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Jarnagin W, Chapman WC, Curley S, et al. Surgical treatment of hepatocellular carcinoma: expert consensus statement. HPB Official J Int Hepato Pancreato Biliary Assoc. 2010;12:302–10.

    Article  Google Scholar 

  8. Berzigotti A, Seijo S, Reverter E, Bosch J. Assessing portal hypertension in liver diseases. Exp Rev Gastroenterol Hepatol. 2013;7:141–55.

    Article  CAS  Google Scholar 

  9. Moulton CA, Gu CS, Law CH, et al. Effect of PET before liver resection on surgical management for colorectal adenocarcinoma metastases: a randomized clinical trial. JAMA. 2014;311:1863–9.

    Article  CAS  PubMed  Google Scholar 

  10. Kubota K, Makuuchi M, Kusaka K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology. 1997;26:1176–81.

    CAS  PubMed  Google Scholar 

  11. Hayashi H, Beppu T, Okabe H, et al. Functional assessment versus conventional volumetric assessment in the prediction of operative outcomes after major hepatectomy. Surgery. 2015;157:20–6.

    Article  PubMed  Google Scholar 

  12. Akiba A, Murata S, Mine T, et al. Volume change and liver parenchymal signal intensity in Gd-EOB-DTPA-enhanced magnetic resonance imaging after portal vein embolization prior to hepatectomy. Biomed Res Int. 2014;2014:684754.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Geisel D, Ludemann L, Hamm B, Denecke T. Imaging-based liver function tests-past, present and future. Rofo. 2015;187:863–71.

    Article  CAS  PubMed  Google Scholar 

  14. Abdalla EK, Barnett CC, Doherty D, Curley SA, Vauthey JN. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg. 2002;137:675–80; discussion 80–1.

    Google Scholar 

  15. Asencio JM, Garcia Sabrido JL, Olmedilla L. How to expand the safe limits in hepatic resections? J Hepato-Biliary-Pancreatic Sci. 2014;21:399–404.

    Google Scholar 

  16. Ribero D, Amisano M, Bertuzzo F, et al. Measured versus estimated total liver volume to preoperatively assess the adequacy of the future liver remnant: which method should we use? Ann Surg. 2013;258:801–6; discussion 6–7.

    Google Scholar 

  17. Ribero D, Abdalla EK, Madoff DC, Donadon M, Loyer EM, Vauthey JN. Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome. Br J Surg. 2007;94:1386–94.

    Article  CAS  PubMed  Google Scholar 

  18. Shindoh J, Truty MJ, Aloia TA, et al. Kinetic growth rate after portal vein embolization predicts posthepatectomy outcomes: toward zero liver-related mortality in patients with colorectal liver metastases and small future liver remnant. J Am Coll Surg. 2013;216:201–9.

    Article  PubMed  Google Scholar 

  19. Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2013;14:1208–15.

    Article  CAS  PubMed  Google Scholar 

  20. Pawlik TM, Olino K, Gleisner AL, Torbenson M, Schulick R, Choti MA. Preoperative chemotherapy for colorectal liver metastases: impact on hepatic histology and postoperative outcome. J Gastrointest Surg Official J Soc Surg Aliment Tract. 2007;11:860–8.

    Article  Google Scholar 

  21. Bischof DA, Clary BM, Maithel SK, Pawlik TM. Surgical management of disappearing colorectal liver metastases. Br J Surg. 2013;100:1414–20.

    Article  CAS  PubMed  Google Scholar 

  22. Teo JY, Allen JC Jr, Ng DC, et al. A systematic review of contralateral liver lobe hypertrophy after unilobar selective internal radiation therapy with Y90. HPB Official J Int Hepato Pancreato Biliary Assoc. 2016;18:7–12.

    Article  Google Scholar 

  23. Maker AV, August C, Maker VK, Weisenberg E. Hepatectomy after yttrium-90 (Y90) radioembolization-induced liver fibrosis. J Gastrointest Surg Official J Soc Surg Aliment Tract. 2016;20:869–70.

    Article  Google Scholar 

  24. Lewandowski RJ, Donahue L, Chokechanachaisakul A, et al. Y radiation lobectomy: outcomes following surgical resection in patients with hepatic tumors and small future liver remnant volumes. J Surg Oncol. 2016;114:99–105.

    Article  PubMed  Google Scholar 

  25. Henry LR, Hostetter RB, Ressler B, et al. Liver resection for metastatic disease after y90 radioembolization: a case series with long-term follow-up. Ann Surg Oncol. 2015;22:467–74.

    Article  PubMed  Google Scholar 

  26. Zhou Y, Xu D, Wu L, Li B. Meta-analysis of anatomic resection versus nonanatomic resection for hepatocellular carcinoma. Langenbeck’s Arch Surg Deut Ges Chirurgie. 2011;396:1109–17.

    Article  Google Scholar 

  27. Mise Y, Aloia TA, Brudvik KW, Schwarz L, Vauthey JN, Conrad C. Parenchymal-sparing hepatectomy in colorectal liver metastasis improves salvageability and survival. Ann Surg. 2016;263:146–52.

    Article  PubMed  Google Scholar 

  28. Strasberg SM. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepato-Biliary-Pancreatic Surg. 2005;12:351–5.

    Article  Google Scholar 

  29. Schiffman SC, Kim KH, Tsung A, Marsh JW, Geller DA. Laparoscopic versus open liver resection for metastatic colorectal cancer: a metaanalysis of 610 patients. Surgery. 2015;157:211–22.

    Article  PubMed  Google Scholar 

  30. Wei M, He Y, Wang J, Chen N, Zhou Z, Wang Z. Laparoscopic versus open hepatectomy with or without synchronous colectomy for colorectal liver metastasis: a meta-analysis. PLoS ONE. 2014;9:e87461.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Yin Z, Fan X, Ye H, Yin D, Wang J. Short- and long-term outcomes after laparoscopic and open hepatectomy for hepatocellular carcinoma: a global systematic review and meta-analysis. Ann Surg Oncol. 2013;20:1203–15.

    Article  PubMed  Google Scholar 

  32. Brouquet A, Mortenson MM, Vauthey JN, et al. Surgical strategies for synchronous colorectal liver metastases in 156 consecutive patients: classic, combined or reverse strategy? J Am Coll Surg. 2010;210:934–41.

    Article  PubMed  Google Scholar 

  33. Kelly ME, Spolverato G, Le GN, et al. Synchronous colorectal liver metastasis: a network meta-analysis review comparing classical, combined, and liver-first surgical strategies. J Surg Oncol. 2015;111:341–51.

    Article  CAS  PubMed  Google Scholar 

  34. Adam R, de Gramont A, Figueras J, et al. Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus. Cancer Treat Rev. 2015;41:729–41.

    Article  PubMed  Google Scholar 

  35. Butte JM, Gonen M, Ding P, et al. Patterns of failure in patients with early onset (synchronous) resectable liver metastases from rectal cancer. Cancer. 2012;118:5414–23.

    Article  PubMed  Google Scholar 

  36. Spolverato G, Ejaz A, Kim Y, et al. Patterns of care among patients undergoing hepatic resection: a query of the national surgical quality improvement program-targeted hepatectomy database. J Surg Res. 2015;196:221–8.

    Article  PubMed  Google Scholar 

  37. Dokmak S, Fteriche FS, Borscheid R, Cauchy F, Farges O, Belghiti J. 2012 Liver resections in the 21st century: we are far from zero mortality. HPB Official J Int Hepato Pancreato Biliary Assoc. 2013;15:908–15.

    Article  Google Scholar 

  38. Rahbari NN, Garden OJ, Padbury R, et al. Posthepatectomy liver failure: a definition and grading by the international study group of liver surgery (ISGLS). Surgery. 2011;149:713–24.

    Article  PubMed  Google Scholar 

  39. Kooby DA, Fong Y, Suriawinata A, et al. Impact of steatosis on perioperative outcome following hepatic resection. J Gastrointest Surg Official J Soc Surg Aliment Tract. 2003;7:1034–44.

    Article  Google Scholar 

  40. Kooby DA, Stockman J, Ben-Porat L, et al. Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg. 2003;237:860–9; discussion 9–70.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Colorado, 12631 E 17th Ave, C-313, 80045, Aurora, CO, USA

    Ana Luiza Mandelli Gleisner MD, PhD

Authors
  1. Ana Luiza Mandelli Gleisner MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ana Luiza Mandelli Gleisner MD, PhD .

Editor information

Editors and Affiliations

  1. Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA

    Jeffrey Meyer

  2. Department of Radiation Oncology, University of Colorado Comprehensive Cancer Center, Aurora, Colorado, USA

    Tracey Schefter

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Gleisner, A.L.M. (2017). Surgical Considerations. In: Meyer, J., Schefter, T. (eds) Radiation Therapy for Liver Tumors. Springer, Cham. https://doi.org/10.1007/978-3-319-54531-8_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-54531-8_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-54530-1

  • Online ISBN: 978-3-319-54531-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation