Surgical strategies to push up resection limits in liver disease and liver failure after surgery

In oncological surgery, the liver still remain a challenge for surgeons. From the seventies, when liver surgery spread, techniques and strategies to approach parenchymal resection are very changed: from a radical surgery, to the finding of liver regeneration capacity and the concept of minimum remnant size, until now, where new liver regeneration theories and new physiological data are changing our approach. In case of HCC, or in case of metastatic disease, when resection is indicated, there are several diagnostic feature to perform before candidate a patient to surgery. How could be safe a liver resection? Which is the phatophysiological etiology of post-hepatectomy liver failure? How could we expand the safe limits for surgery? All these questions are key-points to better understand liver disease, and, moreover, their treatments. From the first meeting with patient affected by liver cancer, we would like to describe how to manage patients, which kinds of imaging we should prefer, how to assess safe limits for resections, and, in case, how to expand this limit. Then, we will focus on interventional radiologic and surgical strategies to approach liver cancer, and how and why posthepatectomy liver failure could be prevented and diagnosed correctly. Particularly, we would focus on portal vein embolization, two-staged hepatectomy, and ALPPS, always with physiological explanation, from the most up-to-date clinical evidence. Particular attention will be made for liver surgery’s sequel and risks. Comparing the newest data available in literature, we will focus on diagnosing, staging and surgical planning to approach liver resections correctly.