Intraoperative Procedures for Metastatic Liver Cancer

The liver is one of the most common sites of metastatic cancer and many of these lesions are amenable to surgical interventions. In the past, major surgical resections were performed for even small lesions on the periphery of the parenchyma. Over the last 10–20 years there have been major advances in surgical resection and ablative techniques allowing for parenchymal preservation as well as durable oncologic outcomes. Advancements in minimally invasive techniques and emerging technologies, specifically laparoscopic and robotic surgery, have decreased postoperative complications and improved outcomes. Associating liver partition and portal vein ligation for staged hepatectomy can offer patients an option if they do not have an adequate future liver remnant. Ablative technologies are developing at a rapid pace and give patients who are not surgical candidates a salvage treatment option. Irreversible electroporation allows for ablation near sensitive structures which was impossible with thermal ablative technologies. In this chapter, these techniques will be discussed in detail and allow the reader to fully understand the scope of the emerging techniques and technologies so that they may be able to understand and utilize these practices to improve patient outcomes.