1. Transileocolic portal vein embolisation

2. Embolisation of Right Hepatic Artery
Spiral embolisation of Right Hepatic Artery
Arteriography of Right Hepatic Artery

3. Liver resection Operative approach
Discussion:
Anatomical vs.
Nonanatomical resection

4. Operative technique – anatomical resection
Liver resection nomenclature based on Couinaud’s classification

5. Anatomical liver resection
Right hepatectomy

6. Operative technique – anatomical resection
Advantage:
Relatively simple operation technique - less bleeding, less postoperative bile leeks;
Survival benefit (some studies):
5 years survival 37% vs. 20%;
Scheele J., Stangl R. et al; World J Surg, 19:59-71,1995
Possibility to increase margin clearence
Solitary lesion > 4 cm had markedly improved outcomes following anatomical resections;
Registry of hepatic metastases, Surgery 103: , 1988
Disadvantage:
Risk of hepatic failure ( fatty liver, cirrhosis);
Not suitable for multiple lesions especially in both lobes