Hepatectomy

Hepatectomy is a surgical procedure involving the removal of liver tissue. It may be partial, including segmentectomy or lobectomy, or extended to remove additional liver segments. Total hepatectomy is not performed as a stand-alone operation; it is part of liver transplantation or staged procedures.

Indications include malignant liver tumors such as hepatocellular carcinoma or colorectal liver metastases, as well as certain benign lesions that require removal. It may also be performed for living donor liver donation.

Preoperative evaluation combines imaging with contrast-enhanced CT or MRI to map tumors and vascular anatomy, assessment of hepatic functional reserve (liver tests, Child-Pugh or MELD score, and sometimes indocyanine green clearance), and planning of future liver remnant. Strategies to augment remnant include portal vein embolization.

Surgical approach can be open, laparoscopic, or robotic. Intraoperatively, inflow (hepatic artery and portal vein) and outflow are controlled, and parenchymal transection is performed with energy devices or ultrasonic tools. The Pringle maneuver or intermittent clamping may reduce blood loss. Resection is categorized as anatomic (within defined vascular territories) or nonanatomic (piecemeal) resection. Intraoperative ultrasound assists margin and vessel identification.

Postoperative care involves monitoring liver function, managing fluids and drains, and surveillance for complications such as bile leak or hepatic insufficiency. Recovery depends on the extent of resection and the underlying liver condition; major resections carry higher risk and longer hospital stays.

Donor hepatectomy describes the removal of a portion of a healthy donor liver for transplantation, typically the right or left lobe, with the donor safely recovering after donation.