Liver: surgical planning

Hepatic surgery for primary malignant disease, either hepatocellular or cholangiocarcinoma, is performed with curative intent, whereas surgery for metastatic disease, either functional endocrine metastases or isolated colorectal metastases, is essentially palliative, aiming to increase duration of survival and quality of life. Patient selection is dependent upon clinical and imaging criteria. The aim of imaging is to define site, size, and multiplicity of tumor in relation to segmental anatomy, vessels and ducts and evaluate for extrahepatic metastatic disease. A multimodality approach employing sonography, CT, MRI and MRCP, and isotope imaging is used as appropriate in each circumstance. The ultimate goal of imaging is to provide a surgeon with anatomic information that will result in a resection with negative free margin or a decision to use resection, ablation, or chemoembolization techniques alone or in concert for best potential outcomes.