One Thousand Fifty-Six Hepatectomies Without Mortality in 8 Years

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Abstract
ALTHOUGH the notion that the liver could be successfully resected was established in the 1950s, liver resection has long been fraught with danger. Many obstacles, such as difficult access because of the high position of the liver under the costal margin, enormous vascularity, no avascular planes, invisible intrahepatic vascular structures concealed by the parenchyma, and a soft, friable structure that denies easy suture ligation, combined to delay the development of liver surgery. It is only during the past 2 decades that liver surgery has advanced dramatically pari passu with the evolution of radiologic imaging, including ultrasound and computed tomography. As a result, the mortality associated with liver resections has decreased to less than 5% in most of the recent studies1-8 from high-volume medical centers and to 0% for selected indications such as liver metastases.9,10 In parallel, the indications for liver resection have been extended, that is, repeated liver resection for recurrent colorectal metastases11,12 and hepatocellular carcinoma (HCC),13,14 extended hepatectomy for hilar bile duct carcinoma,15 and living donor liver transplantation (LDLT) in the adult.16,17 Yet, morbidity and mortality rates in patients with HCC, many of whom have underlying liver cirrhosis,18-20 and in patients with hilar bile duct carcinoma in whom extensive resection of cholestatic liver often becomes necessary15,21-25 are still high, and mortality in adult LDLT donors is presumed to be 0.5% to 1.0%.26