Segmental Liver Resection

Liver resection strategies have evolved over the past two decades, with a marked shift from major hepatectomies to parenchyma-sparing resections (Figure 46.1). Historically, major resections were the norm, with the practice driven by the belief that they were necessary for the treatment of large tumours or extensive disease. Although still often required, they carry a higher risk of post-hepatectomy liver failure (PHLF) and recent studies demonstrate that in western hepato-pancreato-biliary (HPB) centres, the proportion of major hepatectomies has declined to 25–30% of all liver resections. Segmental and local resections are invaluable when managing benign pathologies, dealing with metastases with potential for repeat hepatectomy, and preserving non-tumoral parenchyma in cirrhotic patients.