SURGICAL TREATMENT FOR LIVER CANCER

Recent years have seen a significant advancement in liver surgery, particularly due to new technical possibilities. There has been a marked decrease in morbidity following liver resection which is now less than 3 %. Currently, the five-year survival rate of patients after primary liver resection ranges from 25 to 40 % and about 20 % of patients survive for ten years. At present, the preferred treatment of choice is surgical liver resection (by open or laparoscopic approach), however, the introduction of new combined oncological approaches using biological therapy has resulted in a major improvement in long-term outcomes for both primary and secondary liver tumours. The second treatment of choice is thermal ablation, today mainly represented by radiofrequency and microwave ablation. The long-term outcomes of these methods are less favourable, especially when liver metastases are present, than those of conventional surgical treatment. Only 15–20 % of patients with liver tumours are operable. An increased operability of these patients may be achieved in several ways: by promotion of hepatic tissue regeneration using portal vein embolization of the portal branch at the side of the tumour, or by chemotherapeutic down-staging; both of these are so-called staged procedures. Whether to use simultaneous or consecutive procedures in synchronous metastases of colorectal cancer remains to be answered. The simultaneous procedure is beneficial in simple colorectal resections in which hepatectomy is performed first in order to protect the bowel anastomosis during transient portal hypertension due to closure of the portal vein at the time of liver resection.

Keywords: Key words: liver resection, thermoablative procedures, laparoscopy, combined oncological therapy, portal vein embolization, down-staging, staged procedures, simultaneous procedures.