Wedge resection and enucleation techniques: Hepatic artery infusion chemotherapy

Wedge resection

Wedge resection of peripherally placed lesions within the liver is carried out easily for tumors measuring up to 2 to 3 cm in diameter. However, lesions occupying the convex surface of the liver and away from the free edge, such as lesions within segment VIII, are much more difficult to approach. Wedge resections, especially for lesions situated on the dome of the liver, are fraught with difficulty, not only regarding the control of hemorrhage within the depths of the wedge but also in obtaining tumor-free margins. Because of this, wedge resections of the liver have been shown to be associated with a high local recurrence rate ( ). One of the reasons for this is the likelihood of fracturing the specimen along the interface of the hard tumor and the surrounding soft liver. Certainly for tumors lying well within the substance of the liver and for larger tumors, an anatomic resection, as described in Chapters 2 through 6, is the preferred approach.

Wedge resection is carried out by opening the parenchyma about 2 cm from the lesion and then serially dividing the parenchyma and controlling the portal triads and hepatic veins as they are encountered.

Enucleation techniques

A technique of enucleation that can be applied to the elective management of giant cavernous hemangioma ( Fig. 7.1 ), ensuring minimal blood loss and the preservation of virtually all normal hepatic parenchyma, is described ( , ). A similar technique has been used to enucleate hepatic adenoma, fibronodular hyperplasia, and metastatic neuroendocrine tumors. This approach offers maximal preservation of normal parenchyma and can be carried out as an extension to a formal lobar resection.