Hepatobiliary Surgery Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped hepatobiliary surgery practice.

Liver Resection for Colorectal Metastases

Expanding resectability

Unresectable → Ekberg criteria → expanded criteria → oncosurgical → two-stage/ALPPS

Minimally invasive becomes standard

Open-only → Louisville consensus → Southampton → ORANGE II → Oslo-CoMet RCT → robotic

Centralization saves lives

High mortality → volume-outcome evidence → centralization → technique → ERAS

Don't send them home first

Delayed 6-week → PONCHO (2015) → ACS/SAGES guidelines → implementation gaps

Growing the future liver remnant

Insufficient FLR → PVE (1990s) → ALPPS (2012) → high morbidity → modified techniques