Treatment Options
The treatment of primary and malignant liver tumors depends on the
intrahepatic and extrahepatic extent of the disease and the function of the underlying
liver. The various options in the treatment of focal liver masses are as follows:
Surgical
Nonsurgical
For malignant liver neoplasms, in the absence of extrahepatic
disease, resection with negative pathological margins is the mainstay of treatment. Major
typical or atypical anatomical resections can now be carried out with low morbidity and
minimal mortality. Extended resections – up to 75% of liver – can be safely
performed in patients without underlying liver disease provided liver function is not
compromised by hypotension, infection or ischemic injury. Major typical anatomical
resections with the various nomenclatures used in the surgical literature are outlined in
the following figure.
New techniques such as enucleation or ablation are available where
parenchymal–sparing procedures are needed. In addition, other interventions such as
hepatic artery embolization of tumors and, in some cases, portal vein embolization of a
lobe or more have allowed preoperative downstaging of some tumors and the
"remodeling" of nontumoral hepatic parenchyma in anticipation of major
resection. An accurate diagnosis and precise determination of the extent of disease are
essential.
