Liver surgery: Imaging and image guided therapies

The liver is the most common site of malignant tumors in patients worldwide, including both primary (hepatocellular carcinoma) and metastatic liver cancer (eg colorectal liver metastases). Complete resection or thermal ablation of all tumor deposits currently offers the only potentially curative treatment for patients with a malignancy of the liver. Historically, the liver was considered an organ too fragile and prone to bleeding for elective surgery. Increasing insight in the hepatic vascular and biliary anatomy and the introduction of antisepsis and anesthesia allowed pioneers like Langenbruch and Keene to start performing partial liver resections in the late nineteenth century1,2. Ongoing insight in the hepatic anatomy -like the division of the liver in eight distinct anatomic segments by Couinaud- further encouraged surgeons to perform liver surgery for hepatic neoplasms3. However, until late in the twentieth century, the absence of any form of non-invasive diagnostic imaging severely hampered the application of liver resection at a large scale.

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