Hepatectomies may be anatomic, i.e. the lines of resection match the limits of one or more functional segments of the liver as defined by the Couinaud classification (cf.
[7] The Pringle manoeuvre is usually performed during a hepatectomy to minimize blood loss - however this can lead to reperfusion injury in the liver due to Ischemia.
It has been demonstrated that the intraoperative blood loss during liver resections affects the outcome in terms of postoperative morbidity and mortality.
Pulmonary complications such as atelectasis and pleural effusion are commonplace, and dangerous in patients with underlying lung disease.
It is also a problem, to a lesser degree, in patients with previous hepatectomies (e.g. repeat resections for reincident colorectal cancer metastases).
[citation needed] For optimal results, combination treatment with systemic or regionally infused chemo or biological therapy should be considered.
Prior to surgery, cytotoxic agents such as oxaliplatin given systemically for colorectal metastasis, or chemoembolization for hepatocellular carcinoma can significantly decrease the size of the tumor bulk, allowing then for resections which would remove a segment or wedge portion of the liver only.