Advances in liver surgery.

Techniques for liver surgery have evolved over the past few decades, which have, in turn, allowed for safer operations and have broadened indications for liver resection for benign and malignant liver tumors. Major advances have included appreciation of limiting liver resection to conserve functioning liver tissue and avoid extensive operations that carry a risk of postoperative liver failure, particularly in patients with cirrhosis--the so-called segment-oriented approach to liver resection; multidisciplinary management for patients with malignant liver disease to tailor treatment to each patient depending on tumor burden, condition of the liver, and associated co-morbidity; and development of laparoscopic liver resection to shorten postoperative recovery and reduce postoperative pain. Importantly, it is recommended that liver surgery, whether open or laparoscopic, be done by experienced liver surgeons in centers with the familiarity and resources to address the perioperative needs of these patients.