Transileocolic portal vein embolisation

Embolisation of Right Hepatic Artery

Arteriography of Right Hepatic Artery

Spiral embolisation of Right Hepatic Artery

Liver resection Operative approach

Discussion:

Anatomical vs.

Nonanatomical resection

Operative technique – anatomical resection

Liver resection nomenclature based on Couinaud’s classification

Right hepatectomyRight hepatectomy

Anatomical liver resection

Operative technique – anatomical resection

Advantage:Relatively simple operation technique - less bleeding, less postoperative bile leeks; Survival benefit (some studies):

5 years survival 37% vs. 20%;Scheele J., Stangl R. et al; World J Surg, 19:59-71,1995

Possibility to increase margin clearenceSolitary lesion > 4 cm had markedly improved outcomes following anatomical resections;Registry of hepatic metastases, Surgery 103:278-288, 1988

Disadvantage:Risk of hepatic failure ( fatty liver, cirrhosis);Not suitable for multiple lesions especially in both lobes