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In case of tumor infiltration the hilar bifurcation is removed en-bloc with the liver and the biliary tree is reconstructed by means of a hepatico-jejunostomy. For operative technical reasons, a resection of the hilar bifurcation may be necessary, even without tumor infiltration, i.e. in liver tumors of the right lobe, close to the left umbilical sulcus, with corresponding involvement of the blood circulation of the left hepatic duct. In these cases a resection of the hilar bifurcation is inevitable to avoid ischemia of the hilar bifurcation. In extended hepatectomies even the resection of biliary trees of the second order could be necessary [ 1 – 5 ]

Despite improvements in the management of liver tumours, both primary and metastatic, these tumours are still considered one of the most common malignancies worldwide with a high mortality rate and disappointing long-term survival rates. Hepatic resection has become the standard modality of treatment for patients with liver tumours, and currently remains the only potentially curative therapy. Many factors can affect hepatectomy, such as tumour size, location, multifocality, patients’ status, and hepatic function. But in order to attain a tumour free margin extensive hepatectomy is often necessary, which has led to an increased survival and improved outcome after hepatic resection for liver tumours: colorectal metastases [ 1 – 2 ], hilar cholangiocarcinoma [ 3 – 4 ] and hepatocellular carcinoma [ 5 – 7 ]

End stage liver disease accounts for approximately 1 in 40 deaths world wide. Hepatitis B (HBV) and hepatitis C (HBC) viruses are recognised risk factors for cirrhosis and liver cancer. It has been estimated that, globally, 57% of cases of cirrhosis can be attributable to HBV (30%) or HCV (27%) and that 78% of hepatocellular carcinoma (HCC) is attributable to HBV (53%) or HCV (25%). Applied to 2002 mortality figures these fractions would represent estimates of 929,000 deaths due to chronic HBV and HCV infections, including 446,000 cirrhosis and 483,000 liver cancer deaths [ 1 ]

Primary and secondary liver tumours are common malignancies associated with unsatisfactory treatment and bad prognosis. Hepatocellular carcinoma (HCC) ranks among the 10 most common cancers worldwide and is the most common primary malignancy of the liver. The geographic distribution of HCC is clearly related to the incidence of hepatitis B virus (HBV) infection with the highest incidence in Southeast Asia and tropical Africa

Over the past few years, selective internal radiation therapy (SIRT) has been used clinically for the treatment of non-resectable hepatic metastases in the absence of extrahepatic metastases and in combination with hepatic arterial chemotherapy. The procedure involves using Yttrium-90 microspheres (25–35 u in diameter (fig. 32b. 1), that are injected using a syringe into the hepatic artery via an access route: either a trans-femoral catheter or a permanently implanted hepatic artery port with catheter (fig. 32b.2). Once injected, the spheres travel through the blood stream and target the tumour within the liver, delivering high doses of beta radiation of 0.93 MeV energy, with a maximum 11 mm and mean 2.5 mm penetration distance [ 1 , 2 ]. Treatment takes around 20–30 minutes and is delivered under mild sedation

Surgical advances generally follow either a scientific discovery or a technological breakthrough, for example magnetic resonance imaging or joint replacement. Over the past few years, the advent of new energy sources, such as radiofrequency, has had an increasing impact on surgical practice, especially in the field of liver tumours. Liver resection presently offers the only opportunity for cure in patients with liver cancer, either primary or secondary. Unfortunately, most hepatic cancers are unsuitable for curative resection at the time of diagnosis. Limitations for surgical resection can broadly be classified as either: 1) tumour-related, i.e. lesions that are extremely large, awkwardly sited, multiple, involving major vascular structures, associated with extrahepatic disease or 2) patient-related, i.e. intercurrent medical conditions, old age and poor liver function, especially in those with underlying cirrhosis. Therefore, there is a clear need, for the development of a simple and effective technique to control unresectable tumours within the liver and, preferably, one that avoids a lengthy hos pital stay in patients with limited duration of survival. In the past few years, minimal access has beco me available for the destruction of hepatic carcinomas by methods such as ethanol injection and thermoablation, with cryoprobes, laser or radiofrequency

Those diseases which medicines do not cure, iron (the knife?) cures; those which iron cannot cure, fire cures; and those which fire cannot cure, are to be reckoned wholly incurable

Cirrhosis, the end result of long term liver damage, has long been an important cause of death in UK. The data from Chief Medical Officer in 2001 showed following trends [ 1 ]. Over 4,000 people died from the disease in the last year of the 20th Century, two thirds of them before their 65th birthday. Cirrhosis of the liver is an important cause of illness and death. In 2000 it killed more men than Parkinson’s disease and more women than cancer of the cervix. Large rises in death rates from chronic liver disease and cirrhosis have occurred in most age groups. The rise in deaths from cirrhosis amongst younger people is of particular concern where binge-drinking patterns appear to be common. In 2000 cirrhosis accounted for nearly 500 deaths in men aged 25–44 years and nearly 300 deaths in women of this age group [ 1 ]

The gene therapy dream started well over a decade ago. Despite its wide and successful application in research, it still has not reached the clinics in a meaningful way. No doubt that successful gene therapy has a lot to offer to patients with inherited, benign or malignant diseases

Trauma is the leading cause of death up to the age of 44, while in all age groups trauma related mortality is surpassed only by cancer and atherosclerosis. The liver is the second most commonly injured organ in blunt and the first in penetrating abdominal trauma [ 1 ]. Both blunt and penetrating liver injuries are more common in male adults who drive motor vehicles or engage in fighting. Although the prevalence of blunt liver injury has increased during the past three decades it is not certain whether this represents an actual increase in incidence or an artificial effect due to improvement in diagnostic modalities [ 2 ]. A definite decline in total mortality from complex hepatic injuries has been recorded, from almost 60% before 1990 to 10–15% nowadays [ 3 ]. However, damage to the liver remains the most common cause of death after abdominal injury, being responsible for more than 50% of all deaths after blunt abdominal trauma [ 4 ]. Liver injuries can be detected in up to 25% of patients with blunt trauma if whole-body computed tomography (CT) is performed on every severely injured patient [ 5 ]