Steven A Curley

Chapter Overview 197

Diagnosis and Staging 198

Resection of Malignant Liver Tumors 199

Indications for Resection 199

Stapling Devices in Liver Resection 200

Repeat Hepatectomy for Recurrent Malignant Tumors 202

Portal Vein Embolization 202

Indications for PVE 203

Preoperative Volumetric Determination of the Future Liver

Remnant 203

Approach and Materials for PVE 205

Radiofrequency Ablation 206

Background and Basics of Radiofrequency Tissue

Ablation 206

Indications for RFA of Liver Tumors 210

RFA Treatment Approaches 210

RFA of Primary Liver Tumors 213

Imaging Studies after RFA 214

Regional (Intra-arterial) Chemotherapy 215

Hepatic Arterial Chemoembolization 216

Key Practice Points 216

Suggested Readings 217

Chapter Overview

The advent of modern liver surgery correlates with the development of new diagnostic imaging modalities in the 1970s, when computed tomography, magnetic resonance imaging, and transcutaneous ultrasonography quickly supplanted liver colloid scans and hepatic angiography, the only liver diagnostic radiographic tests available to surgeons previously. The ongoing refinements over the last 30 years in these imaging modalities have provided more precise anatomic definition of tumor size, location, and number, thereby aiding surgeons in planning the extent of hepatic resection. Furthermore, more detailed and accurate anatomic scans of extrahepatic sites have reduced the proportion of patients who undergo an unnecessary laparotomy with no liver resection performed because of a finding of unsuspected extrahepatic spread of malignant disease. Recent use of portal vein embolization at M. D. Anderson Cancer Center and other centers has increased the proportion of patients who are candidates for surgical treatment. New surgical techniques have reduced blood loss, transfusion requirements, and operation time and have improved patient outcomes. There is a glaring need to develop better agents for neoadju-vant and adjuvant therapy in attempts to improve patient survival.

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