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