Milestones in liver surgery

Numerous outstanding summarizing publications on the milestones of the rapid development of liver surgery in the twentieth century came to light around the year 2000, therefore in this summary only the newest principles and novelties of liver surgery after the second millennium are presented. Among the new principles, the newest indications, the bloodless surgery and the vascular exclusion of the liver, the "associating liver partition and portal vein occlusion for staged hepatectomy" (ALPPS) - as presently the fastest and most successful method for liver regeneration, and the "downsizing of tumors" treatment for the interest of resection of unresectable tumours are analyzed and evaluated. Open, laparoscopic, and robotic liver surgery are discussed by comparing blood loss, operating time, cost, and long-term results. Laparoscopic liver surgery on the basis of evidences has become "the method of choice" in our days. Robotic liver surgery needs further evidence-based data for determination of its place in the clinical practice. An intention is also composed in terms of place-determination of liver surgery between gastrointestinal, hepatopancreatobiliary, liver transplantation, and oncologic surgery. The mortality rate has decreased to 1% recently; the data regarding morbidity are variable; the modified Clavien-Dindo, the modified Accordion complication system and the comprehensive complication index are intended to move the different evaluations to a common ground. The up-to-date idea of hepatic surgeon, liver center and liver surgery are defined in close cooperation with international theoretical and practical outcome, in the limelight of multidisciplinarity and multimodality. The internationally observed inequalities in liver surgery are also discussed from the point of view of tackling with the inequalities existing in the universal healthcare systems on a local, national and global level by collecting and controlling the results systematically, and developing and implying international guidelines on the basis of evidences.