Hepatic resection

Hepatic resection in children is indicated for a variety of benign and malignant conditions. Initial diagnosis is usually by ultrasound but MRI or CT scan is usually necessary to further characterize the lesion and to assess for resectability. Benign lesions require resection if they are symptomatic, growing, or have a propensity to rupture. Malignant liver lesions (most commonly hepatoblastoma and hepatocellular carcinoma) almost always require complete resection as part of therapy. In difficult cases, CT-angiography is an excellent imaging modality for surgical planning. The determination of resectability must include consideration of both anatomic and functional resectability. Anatomic resectability depends primarily on the vascular relationships of the tumor, most importantly the hepatic veins followed by the portal veins and hepatic artery branches. Bile ducts should never determine resectability. Functional resectability depends on the size and overall condition of the remaining liver. Ultimately, all liver tumors are resectable with the use of liver transplantation but the potential benefits of this treatment modality must be weighed against the requirement for lifelong immunosuppression and the risks of disease recurrence.