[Primary XXXX : Preoperative conditioning of the liver and perioperative management in extended liver resection].

@entity1 @entity3883 @entity1560 @entity96 @entity5 @entity63 @entity1184 @entity409 @entity189 @entity1578 @entity1448 @entity201
BACKGROUND: Chronic liver parenchymal diseases as well as @entity1448 are established risk factors for @entity1578 after partial hepatectomy. As hepatocellular (HCC) and cholangiocellular (CCC) @entity189 often require extended resection due to the often considerable size of @entity5 - in an often priorly damaged liver - surgery for these entities is usually demanding. Due to the lack of potent systemic treatment for primary @entity96 , surgery remains the only potentially curative treatment option for CCC and most HCC; therefore, perioperative risk factors for @entity1578 should be reduced as far as possible. OBJECTIVES: In this study measures for reducing the risk of @entity1578 after extended liver resections were analyzed. METHODS: This analysis was based on a selective literature search in the Pubmed databank. RESULTS: Medical measures can be used to lower the degree of @entity1560 or the inflammatory reaction of @entity63 /reperfusion injury. In particular, biliary decompression should be achieved in @entity3883 prior to liver surgery, e.g. for @entity201 , as @entity409 . Moreover, the future liver remnant volume after extended liver resection can be increased by embolization (PVE) or ligation of major branches of the portal vein. Similar results as for PVE regarding liver @entity1184 have been reported from unilateral selective internal radiotherapy (SIRT) although this effect appears prolonged and less impressive than after PVE. In addition, two-stage concepts for liver surgery, which are also based on the regenerative potential of the liver, may lower the complication rate and increase @entity1 safety by increasing liver volume. However, conventional two-stage procedures harbor the risk of disease progression during the time lapse to the second step which contraindicates complete resection in 20-30   % of @entity1 . In contrast to this, a complete @entity5 resection is possible in nearly all @entity1 treated by the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure but long-term results regarding @entity5 recurrence rate are scarce due to the limited experience with this novel technique. CONCLUSION: The perioperative risks of extended liver resection can be lowered by technical and medical measures.
