An anatomical liver resection is the removal of a section of the liver defined by its vascularization. As the liver is a solid parenchymatous organ, a branch of the portal vein or hepatic artery needs to be ligated to cut off blood supply to a particular part of the liver. This creates a demarcation line, indicated by discoloration due to blood flow interruption, which guides the removal of the affected part. Types of anatomical liver resections include right and left hepatectomy, right and left extended hepatectomy, sectorectomy, central liver resection (mesohepatectomy), segmentectomy, and anatomical subsegmentectomy.
Liver-sparing (parenchyma-preserving) operations do not follow the boundaries of anatomical units. Instead, the transection plane deviates from those boundaries to be oncologically optimal (with a negative resection margin) and to spare liver tissue, minimizing the risk of postoperative insufficient liver function due to a small residual volume. Such operations can sometimes even enable resection of previously unresectable cases. One such exclusive operation, known as “TUNNEL” through the liver, is performed successfully in a small number of centres worldwide.
Anatomical resections of the liver are indicated for treating hepatocellular carcinoma or tumours that affect a significant part of an anatomical unit. Liver-sparing operations are typically used for colon cancer metastases.
Liver surgery is a highly challenging procedure due to the liver’s specific structure and vital functions. Complications that may arise following liver resection include bleeding at the surgical site, reactive effusion formation in the lung tissue, and the appearance of biliary content in the resection region caused by injury to the biliary duct. Accumulation of biliary content in the abdomen can lead to infection, but such complications rarely require a second operation to resolve them.
After extensive liver resection, the patient spends one night in the intensive care unit, while a smaller resection with no complications results in the patient staying in the semi-intensive care unit on the first postoperative night. Liquid and mushy food can be consumed as early as the first day after the operation. Patients can typically get up on their own from the first or second postoperative day. The expected hospital stay after the operation is between 5 to 7 days.
