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Anatomic Considerations in the Surgical Resection of Hepatocellular Carcinoma

Yoo, Peter S. MD*; Enestvedt, C. Kristian MD; Kulkarni, Sanjay MD*

Journal of Clinical Gastroenterology: July 2013 - Volume 47 - Issue - p S11–S15
doi: 10.1097/MCG.0b013e318280ce5f

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and is a common cause of cancer death worldwide. Treatment of HCC usually consists of combinations of locoregional therapy, surgical resection, orthotopic liver transplantation, and in advanced cases, systemic chemotherapy. The best rates of cure are achieved with surgical resection or orthotopic liver transplantation in well-selected patients. The success of surgical resection depends on the adequacy of the extent of resection, balanced with the need to preserve functional hepatic parenchyma. Nonanatomic resection for HCC has been proposed as a surgical technique to maximize residual liver mass, but has been shown by some to yield inferior oncologic outcomes compared with formal anatomic resection. This review discusses relevant surgical anatomy of the liver, classifications of hepatic resection, and the current literature regarding outcomes of anatomic and nonanatomic resection of the liver.

*Department of Surgery, Section of Transplantation and Immunology, Yale School of Medicine, New Haven, CT

Perelman School of Medicine, Penn Transplant Institute, Philadelphia, PA

The authors declare that they have nothing to disclose.

Reprints: Peter S. Yoo, MD, Department of Surgery, Section of Transplantation and Immunology, Yale School of Medicine, 333 Cedar Street, FMB 121, New Haven, CT 06510 (e-mail:

© 2013 by Lippincott Williams & Wilkins