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Semin Liver Dis 2013; 33(03): 273-281
DOI: 10.1055/s-0033-1351782
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Resection Strategies for Hepatocellular Carcinoma

Tiffany Cho Lam Wong
1   Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
,
Chung Mau Lo
1   Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
› Author Affiliations
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Publication History

Publication Date:
13 August 2013 (online)

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Abstract

Liver resection is the treatment of choice and standard of care in patients with hepatocellular carcinoma (HCC). The ultimate goal of liver resection in HCC patients is to resect primary tumor with an adequate margin while preserving as much functional liver parenchyma as possible. Tremendous improvements in perioperative outcomes after liver resection have been achieved in the past three decades. The overall and disease-free survival rates have also improved. Liver resection is feasible and safe even in cirrhotic patients. This is a result of more accurate preoperative evaluation of liver function, the ability to manipulate future liver remnant volume, the use of anatomical resection and an anterior approach, meticulous surgical techniques to achieve bloodless liver resection, and better perioperative care. The purpose of this review is to highlight the importance of different resection strategies for HCC that in turn have contributed to the safety and improvement in long-term outcomes after liver resection.

Keywords

hepatocellular carcinoma - liver resection - bloodless liver resection - resection strategy
 

  • Reference

  • 1 Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10. Lyon, France: International Agency for Research on Cancer; 2010. Available from: http://globocan.iarc.fr . Accessed January 18, 2013
    PubMedGoogle Scholar
  • 2 Bruix J, Sherman M. American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53 (3) 1020-1022
    CrossrefPubMedGoogle Scholar
  • 3 Omata M, Lesmana LA, Tateishi R , et al. Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 2010; 4 (2) 439-474
    CrossrefPubMedGoogle Scholar
  • 4 Fan ST, Mau Lo C, Poon RT , et al. Continuous improvement of survival outcomes of resection of hepatocellular carcinoma: a 20-year experience. Ann Surg 2011; 253 (4) 745-758
    CrossrefPubMedGoogle Scholar
  • 5 Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973; 60 (8) 646-649
    CrossrefPubMedGoogle Scholar
  • 6 Santambrogio R, Kluger MD, Costa M , et al. Hepatic resection for hepatocellular carcinoma in patients with Child-Pugh's A cirrhosis: is clinical evidence of portal hypertension a contraindication?. HPB (Oxford) 2013; 15 (1) 78-84
    CrossrefPubMedGoogle Scholar
  • 7 Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 2000; 31 (4) 864-871
    CrossrefPubMedGoogle Scholar
  • 8 Freeman Jr RB, Wiesner RH, Harper A , et al; UNOS/OPTN Liver Disease Severity Score, UNOS/OPTN Liver and Intestine, and UNOS/OPTN Pediatric Transplantation Committees. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl 2002; 8 (9) 851-858
    CrossrefPubMedGoogle Scholar
  • 9 Cucchetti A, Ercolani G, Vivarelli M , et al. Impact of model for end-stage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis. Liver Transpl 2006; 12 (6) 966-971
    CrossrefPubMedGoogle Scholar
  • 10 Delis SG, Bakoyiannis A, Biliatis I, Athanassiou K, Tassopoulos N, Dervenis C. Model for end-stage liver disease (MELD) score, as a prognostic factor for post-operative morbidity and mortality in cirrhotic patients, undergoing hepatectomy for hepatocellular carcinoma. HPB (Oxford) 2009; 11 (4) 351-357
    CrossrefPubMedGoogle Scholar
  • 11 Delis SG, Bakoyiannis A, Dervenis C, Tassopoulos N. Perioperative risk assessment for hepatocellular carcinoma by using the MELD score. J Gastrointest Surg 2009; 13 (12) 2268-2275
    CrossrefPubMedGoogle Scholar
  • 12 Kwon AH, Matsui Y, Kaibori M, Ha-Kawa SK. Preoperative regional maximal removal rate of technetium-99m-galactosyl human serum albumin (GSA-Rmax) is useful for judging the safety of hepatic resection. Surgery 2006; 140 (3) 379-386
    CrossrefPubMedGoogle Scholar
  • 13 Cucchetti A, Cescon M, Trevisani F, Pinna AD. Current concepts in hepatic resection for hepatocellular carcinoma in cirrhotic patients. World J Gastroenterol 2012; 18 (44) 6398-6408
    CrossrefPubMedGoogle Scholar
  • 14 Hoekstra LT, de Graaf W, Nibourg GA , et al. Physiological and biochemical basis of clinical liver function tests: a review. Ann Surg 2013; 257 (1) 27-36
    CrossrefPubMedGoogle Scholar
  • 15 Fan ST. Liver functional reserve estimation: state of the art and relevance for local treatments: the Eastern perspective. J Hepatobiliary Pancreat Sci 2010; 17 (4) 380-384
    CrossrefPubMedGoogle Scholar
  • 16 Lam CM, Fan ST, Lo CM, Wong J. Major hepatectomy for hepatocellular carcinoma in patients with an unsatisfactory indocyanine green clearance test. Br J Surg 1999; 86 (8) 1012-1017
    CrossrefPubMedGoogle Scholar
  • 17 Schindl MJ, Redhead DN, Fearon KC, Garden OJ, Wigmore SJ. Edinburgh Liver Surgery and Transplantation Experimental Research Group (eLISTER). The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut 2005; 54 (2) 289-296
    CrossrefPubMedGoogle Scholar
  • 18 Brouquet A, Andreou A, Shindoh J, Vauthey JN. Methods to improve resectability of hepatocellular carcinoma. Recent Results Cancer Res 2013; 190: 57-67
    PubMedGoogle Scholar
  • 19 Ribero D, Chun YS, Vauthey JN. Standardized liver volumetry for portal vein embolization. Semin Intervent Radiol 2008; 25 (2) 104-109
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Fan ST. Hepatocellular carcinoma—resection or transplant?. Nat Rev Gastroenterol Hepatol 2012; 9 (12) 732-737
    CrossrefPubMedGoogle Scholar
  • 21 Breitenstein S, Apestegui C, Petrowsky H, Clavien PA. “State of the art” in liver resection and living donor liver transplantation: a worldwide survey of 100 liver centers. World J Surg 2009; 33 (4) 797-803
    CrossrefPubMedGoogle Scholar
  • 22 Rous P, Larimore LD. Relation of the portal blood to liver maintenance: a demonstration of liver atrophy conditional on compensation. J Exp Med 1920; 31 (5) 609-632
    CrossrefPubMedGoogle Scholar
  • 23 Kinoshita H, Sakai K, Hirohashi K, Igawa S, Yamasaki O, Kubo S. Preoperative portal vein embolization for hepatocellular carcinoma. World J Surg 1986; 10 (5) 803-808
    Google Scholar
  • 24 Abulkhir A, Limongelli P, Healey AJ , et al. Preoperative portal vein embolization for major liver resection: a meta-analysis. Ann Surg 2008; 247 (1) 49-57
    CrossrefPubMedGoogle Scholar
  • 25 Farges O, Belghiti J, Kianmanesh R , et al. Portal vein embolization before right hepatectomy: prospective clinical trial. Ann Surg 2003; 237 (2) 208-217
    Google Scholar
  • 26 Seo DD, Lee HC, Jang MK , et al. Preoperative portal vein embolization and surgical resection in patients with hepatocellular carcinoma and small future liver remnant volume: comparison with transarterial chemoembolization. Ann Surg Oncol 2007; 14 (12) 3501-3509
    CrossrefPubMedGoogle Scholar
  • 27 Okabe H, Beppu T, Ishiko T , et al. Preoperative portal vein embolization (PVE) for patients with hepatocellular carcinoma can improve resectability and may improve disease-free survival. J Surg Oncol 2011; 104 (6) 641-646
    CrossrefPubMedGoogle Scholar
  • 28 Clavien PA, Petrowsky H, DeOliveira ML, Graf R. Strategies for safer liver surgery and partial liver transplantation. N Engl J Med 2007; 356 (15) 1545-1559
    CrossrefPubMedGoogle Scholar
  • 29 Yamamoto J, Kosuge T, Takayama T , et al. Recurrence of hepatocellular carcinoma after surgery. Br J Surg 1996; 83 (9) 1219-1222
    CrossrefPubMedGoogle Scholar
  • 30 Hasegawa K, Kokudo N, Imamura H , et al. Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg 2005; 242 (2) 252-259
    CrossrefPubMedGoogle Scholar
  • 31 Lai ECS, You KT, Ng IOL, Shek TW. The pathological basis of resection margin for hepatocellular carcinoma. World J Surg 1993; 17 (6) 786-790 , discussion 791
    CrossrefPubMedGoogle Scholar
  • 32 Tang YH, Wen TF, Chen X. Resection margin in hepatectomy for hepatocellular carcinoma: a systematic review. Hepatogastroenterology 2012; 59 (117) 1393-1397
    PubMedGoogle Scholar
  • 33 Yoshida H, Katayose Y, Rikiyama T , et al. Segmentectomy of the liver. J Hepatobiliary Pancreat Sci 2012; 19 (1) 67-71
    CrossrefPubMedGoogle Scholar
  • 34 Poon RT. Prevention of recurrence after resection of hepatocellular carcinoma: a daunting challenge. Hepatology 2011; 54 (3) 757-759
    CrossrefPubMedGoogle Scholar
  • 35 Kobayashi T, Ishiyama K, Ohdan H. Prevention of recurrence after curative treatment for hepatocellular carcinoma. Surg Today 2012; . Epub ahead of print
    PubMedGoogle Scholar
  • 36 Tanaka K, Shimada H, Matsumoto C , et al. Anatomic versus limited nonanatomic resection for solitary hepatocellular carcinoma. Surgery 2008; 143 (5) 607-615
    CrossrefPubMedGoogle Scholar
  • 37 Cho YB, Lee KU, Lee HW , et al. Anatomic versus non-anatomic resection for small single hepatocellular carcinomas. Hepatogastroenterology 2007; 54 (78) 1766-1769
    PubMedGoogle Scholar
  • 38 Wakai T, Shirai Y, Sakata J , et al. Anatomic resection independently improves long-term survival in patients with T1-T2 hepatocellular carcinoma. Ann Surg Oncol 2007; 14 (4) 1356-1365
    CrossrefPubMedGoogle Scholar
  • 39 Eguchi S, Kanematsu T, Arii S , et al; Liver Cancer Study Group of Japan. Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey. Surgery 2008; 143 (4) 469-475
    CrossrefPubMedGoogle Scholar
  • 40 Chen J, Huang K, Wu J , et al. Survival after anatomic resection versus nonanatomic resection for hepatocellular carcinoma: a meta-analysis. Dig Dis Sci 2011; 56 (6) 1626-1633
    CrossrefPubMedGoogle Scholar
  • 41 Zhou Y, Xu D, Wu L, Li B. Meta-analysis of anatomic resection versus nonanatomic resection for hepatocellular carcinoma. Langenbecks Arch Surg 2011; 396 (7) 1109-1117
    CrossrefPubMedGoogle Scholar
  • 42 Cucchetti A, Cescon M, Ercolani G, Bigonzi E, Torzilli G, Pinna AD. A comprehensive meta-regression analysis on outcome of anatomic resection versus nonanatomic resection for hepatocellular carcinoma. Ann Surg Oncol 2012; 19 (12) 3697-3705
    CrossrefPubMedGoogle Scholar
  • 43 Lehmann K, Clavien PA. History of hepatic surgery. Surg Clin North Am 2010; 90 (4) 655-664
    CrossrefPubMedGoogle Scholar
  • 44 Katz SC, Shia J, Liau KH , et al. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg 2009; 249 (4) 617-623
    CrossrefPubMedGoogle Scholar
  • 45 Rahbari NN, Koch M, Schmidt T , et al. Meta-analysis of the clamp-crushing technique for transection of the parenchyma in elective hepatic resection: back to where we started?. Ann Surg Oncol 2009; 16 (3) 630-639
    CrossrefPubMedGoogle Scholar
  • 46 Takayama T, Makuuchi M, Kubota K , et al. Randomized comparison of ultrasonic vs clamp transection of the liver. Arch Surg 2001; 136 (8) 922-928
    CrossrefPubMedGoogle Scholar
  • 47 Lesurtel M, Selzner M, Petrowsky H, McCormack L, Clavien PA. How should transection of the liver be performed?: a prospective randomized study in 100 consecutive patients: comparing four different transection strategies. Ann Surg 2005; 242 (6) 814-822 , discussion 822–823
    CrossrefPubMedGoogle Scholar
  • 48 Aldrighetti L, Pulitanò C, Arru M, Catena M, Finazzi R, Ferla G. “Technological” approach versus clamp crushing technique for hepatic parenchymal transection: a comparative study. J Gastrointest Surg 2006; 10 (7) 974-979
    CrossrefPubMedGoogle Scholar
  • 49 Ikeda M, Hasegawa K, Sano K , et al. The vessel sealing system (LigaSure) in hepatic resection: a randomized controlled trial. Ann Surg 2009; 250 (2) 199-203
    CrossrefPubMedGoogle Scholar
  • 50 Geller DA, Tsung A, Maheshwari V, Rutstein LA, Fung JJ, Marsh JW. Hepatic resection in 170 patients using saline-cooled radiofrequency coagulation. HPB (Oxford) 2005; 7 (3) 208-213
    CrossrefPubMedGoogle Scholar
  • 51 Celinski SA, Gamblin TC. Hepatic resection nomenclature and techniques. Surg Clin North Am 2010; 90 (4) 737-748
    CrossrefPubMedGoogle Scholar
  • 52 Man K, Fan ST, Ng IO, Lo CM, Liu CL, Wong J. Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study. Ann Surg 1997; 226 (6) 704-711 , discussion 711–713
    CrossrefPubMedGoogle Scholar
  • 53 Hoekstra LT, van Trigt JD, Reiniers MJ, Busch OR, Gouma DJ, van Gulik TM. Vascular occlusion or not during liver resection: the continuing story. Dig Surg 2012; 29 (1) 35-42
    CrossrefPubMedGoogle Scholar
  • 54 Gurusamy KS, Sheth H, Kumar Y, Sharma D, Davidson BR. Methods of vascular occlusion for elective liver resections. Cochrane Database Syst Rev 2009; 1 (1) CD007632
    PubMedGoogle Scholar
  • 55 Richardson AJ, Laurence JM, Lam VW. Portal triad clamping versus other methods of vascular control in liver resection: a systematic review and meta-analysis. HPB (Oxford) 2012; 14 (6) 355-364
    CrossrefPubMedGoogle Scholar
  • 56 Poon RT, Fan ST, Lo CM , et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 2004; 240 (4) 698-708 , discussion 708–710
    PubMedGoogle Scholar
  • 57 Viganò L, Jaffary SA, Ferrero A, Russolillo N, Langella S, Capussotti L. Liver resection without pedicle clamping: feasibility and need for “salvage clamping.” Looking for the right clamping policy. Analysis of 512 consecutive resections. J Gastrointest Surg 2011; 15 (10) 1820-1828
    CrossrefPubMedGoogle Scholar
  • 58 Moug SJ, Smith D, Leen E, Angerson WJ, Horgan PG. Selective continuous vascular occlusion and perioperative fluid restriction in partial hepatectomy. Outcomes in 101 consecutive patients. Eur J Surg Oncol 2007; 33 (8) 1036-1041
    CrossrefPubMedGoogle Scholar
  • 59 Melendez JA, Arslan V, Fischer ME , et al. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg 1998; 187 (6) 620-625
    CrossrefPubMedGoogle Scholar
  • 60 Gurusamy KS, Li J, Vaughan J, Sharma D, Davidson BR. Cardiopulmonary interventions to decrease blood loss and blood transfusion requirements for liver resection. Cochrane Database Syst Rev 2012; 5: CD007338
    PubMedGoogle Scholar
  • 61 Tiong L, Maddern GJ. Systematic review and meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma. Br J Surg 2011; 98 (9) 1210-1224
    CrossrefPubMedGoogle Scholar
  • 62 Salhab M, Canelo R. An overview of evidence-based management of hepatocellular carcinoma: a meta-analysis. J Cancer Res Ther 2011; 7 (4) 463-475
    CrossrefPubMedGoogle Scholar
  • 63 Weber JC, Navarra G, Jiao LR, Nicholls JP, Jensen SL, Habib NA. New technique for liver resection using heat coagulative necrosis. Ann Surg 2002; 236 (5) 560-563
    CrossrefPubMedGoogle Scholar
  • 64 Curro G, Habib N, Jiao L, Baccarani U, Scisca C, Navarra G. Radiofrequency-assisted liver resection in patients with hepatocellular carcinoma and cirrhosis: preliminary results. Transplant Proc 2008; 40 (10) 3523-3525
    CrossrefPubMedGoogle Scholar
  • 65 Pai M, Frampton AE, Mikhail S , et al. Radiofrequency assisted liver resection: analysis of 604 consecutive cases. Eur J Surg Oncol 2012; 38 (3) 274-280
    CrossrefPubMedGoogle Scholar
  • 66 Delis S, Bakoyiannis A, Tassopoulos N , et al. Clamp-crush technique vs. radiofrequency-assisted liver resection for primary and metastatic liver neoplasms. HPB (Oxford) 2009; 11 (4) 339-344
    CrossrefPubMedGoogle Scholar
  • 67 Li M, Zhang W, Li Y , et al. Radiofrequency-assisted versus clamp-crushing parenchyma transection in cirrhotic patients with hepatocellular carcinoma: a randomized clinical trial. Dig Dis Sci 2013; 58 (3) 835-840
    CrossrefPubMedGoogle Scholar
  • 68 Torzilli G, Donadon M, Montorsi M, Makuuchi M. Concerns about ultrasound-guided radiofrequency-assisted segmental liver resection. Ann Surg 2010; 251 (6) 1191-1192 , author reply 1192–1193
    PubMedGoogle Scholar
  • 69 Lai EC, Fan ST, Lo CM, Chu KM, Liu CL. Anterior approach for difficult major right hepatectomy. World J Surg 1996; 20 (3) 314-317 , discussion 318
    CrossrefPubMedGoogle Scholar
  • 70 Liu CL, Fan ST, Lo CM, Tung-Ping Poon R, Wong J. Anterior approach for major right hepatic resection for large hepatocellular carcinoma. Ann Surg 2000; 232 (1) 25-31
    CrossrefPubMedGoogle Scholar
  • 71 Liu CL, Fan ST, Cheung ST, Lo CM, Ng IO, Wong J. Anterior approach versus conventional approach right hepatic resection for large hepatocellular carcinoma: a prospective randomized controlled study. Ann Surg 2006; 244 (2) 194-203
    CrossrefPubMedGoogle Scholar
  • 72 Belghiti J, Guevara OA, Noun R, Saldinger PF, Kianmanesh R. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg 2001; 193 (1) 109-111
    CrossrefPubMedGoogle Scholar
  • 73 Belghiti J. Editorial perspective: Resection of large hepatocellular carcinoma using combination of liver hanging maneuver and anterior approach. World J Surg 2010; 34 (8) 1879-1880
    CrossrefPubMedGoogle Scholar
  • 74 Ogata S, Belghiti J, Varma D , et al. Two hundred liver hanging maneuvers for major hepatectomy: a single-center experience. Ann Surg 2007; 245 (1) 31-35
    CrossrefPubMedGoogle Scholar
  • 75 Wang CC, Jawade K, Yap AQ, Concejero AM, Lin CY, Chen CL. Resection of large hepatocellular carcinoma using the combination of liver hanging maneuver and anterior approach. World J Surg 2010; 34 (8) 1874-1878
    CrossrefPubMedGoogle Scholar
  • 76 Wu TJ, Wang F, Lin YS, Chan KM, Yu MC, Lee WC. Right hepatectomy by the anterior method with liver hanging versus conventional approach for large hepatocellular carcinomas. Br J Surg 2010; 97 (7) 1070-1078
    CrossrefPubMedGoogle Scholar
  • 77 Mazzaferro V, Regalia E, Doci R , et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996; 334 (11) 693-699
    CrossrefPubMedGoogle Scholar
  • 78 Fan ST, Poon RT, Yeung C , et al. Outcome after partial hepatectomy for hepatocellular cancer within the Milan criteria. Br J Surg 2011; 98 (9) 1292-1300
    CrossrefPubMedGoogle Scholar
  • 79 Liu CL, Fan ST, Lo CM, Ng IO, Poon RT, Wong J. Hepatic resection for bilobar hepatocellular carcinoma: is it justified?. Arch Surg 2003; 138 (1) 100-104
    CrossrefPubMedGoogle Scholar
  • 80 Ng KK, Vauthey JN, Pawlik TM , et al; International Cooperative Study Group on Hepatocellular Carcinoma. Is hepatic resection for large or multinodular hepatocellular carcinoma justified? Results from a multi-institutional database. Ann Surg Oncol 2005; 12 (5) 364-373
    CrossrefPubMedGoogle Scholar
  • 81 Ishizawa T, Hasegawa K, Aoki T , et al. Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinoma. Gastroenterology 2008; 134 (7) 1908-1916
    CrossrefPubMedGoogle Scholar
  • 82 Ramacciato G, Mercantini P, Petrucciani N , et al. Does surgical resection have a role in the treatment of large or multinodular hepatocellular carcinoma?. Am Surg 2010; 76 (11) 1189-1197
    PubMedGoogle Scholar
  • 83 Marelli L, Stigliano R, Triantos C , et al. Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol 2007; 30 (1) 6-25
    CrossrefPubMedGoogle Scholar
  • 84 Cheung TT, Ng KK, Chok KS , et al. Combined resection and radiofrequency ablation for multifocal hepatocellular carcinoma: prognosis and outcomes. World J Gastroenterol 2010; 16 (24) 3056-3062
    CrossrefPubMedGoogle Scholar
  • 85 Belghiti J, Kianmanesh R. Surgical treatment of hepatocellular carcinoma. HPB (Oxford) 2005; 7 (1) 42-49
    CrossrefPubMedGoogle Scholar
  • 86 Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 2000; 191 (1) 38-46
    CrossrefPubMedGoogle Scholar
  • 87 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 (4) 397-406 , discussion 406–407
    CrossrefPubMedGoogle Scholar
  • 88 Imamura H, Seyama Y, Kokudo N , et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 2003; 138 (11) 1198-1206 , discussion 1206
    CrossrefPubMedGoogle Scholar
  • 89 Kamiyama T, Nakanishi K, Yokoo H , et al. Perioperative management of hepatic resection toward zero mortality and morbidity: analysis of 793 consecutive cases in a single institution. J Am Coll Surg 2010; 211 (4) 443-449
    CrossrefPubMedGoogle Scholar