Advances in operative, diagnostic and post-operative care technique have rendered liver resections safe. Consecutively, indications for operative interventions in primary and secondary liver
tumors have changed. A current state of the art is presented.
Focal nodular hyperplasia, if found incidentally during
laparotomy, should be removed en-passant. Large or central lesions should be biopsied and can be observed if they remain asymptomatic and stable in size. Symptomatic or growing FNH should be removed. If the diagnosis is evasive resection should be favored. Most patients with
hepatocellular adenoma are symptomatic and the lesion should therefore be removed.
Hemangiomas are rarely causing symptoms. In case they truly are, or if they cause complications they should be excised. Anatomical resections for
hepatocellular carcinoma are only feasible in non-cirrhotic livers or in patients with
cirrhosis and compensated liver function. Other patients are candidates for
liver transplantation if the
cancer is stage I or II. Stage III and IVa lesions are subject of current studies. Surgical resection remains the only potentially curative treatment for intrahepatic
cholangiocellular carcinoma. Because of their dismal prognosis these patients are not candidates for
transplantation. Resection continues to be the most effective
therapy for colorectal
metastases to the liver. Patients with non-colorectal, non-neuroendocrine
metastases are usually only candidates for surgical palliation. Cure can be achieved in patients with
renal cell carcinoma or
Wilms' tumor. Additionally, neuroendocrine
metastases to the liver can be resected in curative intent if extrahepatic disease was excluded. In the few symptomatic patients in whom extrahepatic disease was excluded, symptomatic treatment has failed, and the lesions are not resectable,
liver transplantation can provide a reasonable therapeutic choice.