Preservation of as much liver parenchyma is important since many patients will receive preoperative chemotherapy and risks of liver failure are much higher. It is accepted that no more than six cycles of chemotherapy is to be used preoperatively. In situations where more than six cycles of chemotherapy are used, the surgical approach should be modified to permit less liver ischemia time during transection. Pringle maneuver is generally not used in transecting liver parenchyma with CUSA, ERBE, or TissueLink. In these cases where patients are at higher risk of liver failure use of these instruments may prove beneficial. Although the Cochrane database shows that Inhibitors,research,lifescience,medical no parenchymal Inhibitors,research,lifescience,medical technique

is superior to the

crush-clamp and vessel ligation technique in regards to bile leaks, bleeding, and liver failure, it does not specifically address the complications in relation to colorectal liver metastasis. There is literature to support an individual’s use of a preferred technique over another technique with low morbidity. The key point is repetition in one technique allows a surgeon to ACY-1215 clinical trial become very comfortable Inhibitors,research,lifescience,medical in that method. Subsequently, after the learning curve the rates of complications decrease. Due to the complexity of liver resections in colorectal liver metastasis, surgeons should be comfortable in utilizing different approaches. The radiofrequency ablation method provides sealing of biliary radicals and small vessels but not larger vasculature and should be used with caution during deeper dissection in the liver. The open surgical approach to liver resection will continue to grow and develop with technology. With growing

interest Inhibitors,research,lifescience,medical in minimally invasive approach to liver resection, this adds an additional tool to the technology available for open surgery. It is important for surgeons to understand that laparoscopy or the robot is another tool in performing liver resection. The gold standard will always be open surgery. Patient selection and surgeon experience Inhibitors,research,lifescience,medical are critically important to the success of minimally invasive liver resection. mafosfamide Due to the complexity of liver surgery, this approach should be reserved for specialized institutions that are involved in not only doing these cases routinely, but training other surgeons in minimally invasive technique as well. Finally, it is important that surgeons understand the risks, benefits, and costs of various surgical approaches to liver resection for colorectal metastasis. In an era where focus is placed on cost savings in medicine, comparing the cost benefit of the different techniques in liver resection will play an important role in how we manage these patients. Footnotes No potential conflict of interest.
Colorectal cancer represents the third most common malignancy in the United States afflicting 140,000 patients annually.