Published online Mar 7, 2016. doi: 10.3748/wjg.v22.i9.2725
Peer-review started: September 23, 2015
First decision: October 14, 2015
Revised: November 1, 2015
Accepted: December 30, 2015
Article in press: December 30, 2015
Published online: March 7, 2016
The prevalence of hepatic cirrhosis in Europe and the United States, currently 250 patients per 100000 inhabitants, is steadily increasing. Thus, we observe a significant increase in patients with cirrhosis and portal hypertension needing liver resections for primary or metastatic lesions. However, extended liver resections in patients with underlying hepatic cirrhosis and portal hypertension still represent a medical challenge in regard to perioperative morbidity, surgical management and postoperative outcome. The Barcelona Clinic Liver Cancer classification recommends to restrict curative liver resections for hepatocellular carcinoma in cirrhotic patients to early tumor stages in patients with Child A cirrhosis not showing portal hypertension. However, during the last two decades, relevant improvements in preoperative diagnostic, perioperative hepatologic and intensive care management as well as in surgical techniques during hepatic resections have rendered even extended liver resections in higher-degree cirrhotic patients with portal hypertension possible. However, there are few standard indications for hepatic resections in cirrhotic patients and risk stratifications have to be performed in an interdisciplinary setting for each individual patient. We here review the indications, the preoperative risk-stratifications, the morbidity and the mortality of extended resections for primary and metastatic lesions in cirrhotic livers. Furthermore, we provide a review of literature on perioperative management in cirrhotic patients needing extrahepatic abdominal surgery and an overview of surgical options in the treatment of hepatic cirrhosis.
Core tip: Liver resections in patients with underlying hepatic cirrhosis and portal hypertension still represent a medical challenge with regard to perioperative morbidity, surgical management and postoperative outcome. However, the increasing incidence of liver cirrhosis on the one hand, and the ongoing improvements in surgical technique and perioperative management on the other hand have up until today rendered even extended hepatic resections in these patients possible. Especially in primary and metastatic liver malignancies, surgery often presents the only curative approach and thus potential short- and long-term benefits and risks have to be evaluated carefully and interdisciplinary from a surgical, oncological and hepatologist point of view.