The liver is the most common site of malignant tumors in patients worldwide,
including both primary (hepatocellular carcinoma) and metastatic liver cancer (eg
colorectal liver metastases). Complete resection or thermal ablation of all tumor
deposits currently offers the only potentially curative treatment for patients with a
malignancy of the liver.
Historically, the liver was considered an organ too fragile and prone to bleeding for
elective surgery. Increasing insight in the hepatic vascular and biliary anatomy and
the introduction of antisepsis and anesthesia allowed pioneers like Langenbruch
and Keene to start performing partial liver resections in the late nineteenth
century1,2. Ongoing insight in the hepatic anatomy -like the division of the liver in
eight distinct anatomic segments by Couinaud- further encouraged surgeons to
perform liver surgery for hepatic neoplasms3. However, until late in the twentieth
century, the absence of any form of non-invasive diagnostic imaging severely
hampered the application of liver resection at a large scale