Tom Reeve Academic Surgical Clinic  ·  St Leonards

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Thomas J. HughSpecialist Hepato-Biliary & General Surgeon
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Research · Liver surgery

Liver resection and HPB surgery evidence

Liver resection and complex hepatectomy sit at the core of Thomas J. Hugh's academic work. From bile leak grading to portal vein embolization before major HPB surgery, Tom Hugh publishes international standards used in Sydney centres including Royal North Shore.

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This page explains liver resection in plain language, alongside peer-reviewed work by Thomas J. Hugh and colleagues.

Plain-language patient guide→
/ 01Overview

What is liver resection (hepatectomy)?

Liver resection removes part of the liver while preserving enough healthy tissue for the body to function. Hepatectomy treats primary liver cancers, colorectal metastases, and some benign tumours. The liver can regenerate, which makes staged or portal vein embolization strategies possible when the future liver remnant would otherwise be too small.

HPB surgery Sydney patients are assessed in multidisciplinary teams with imaging, anaesthesia, and intensive care input.

Hugh contributed to International Study Group of Liver Surgery (ISGLS) definitions that standardise reporting after hepatectomy worldwide.

/ 02Evidence

What is portal vein embolization before major hepatectomy?

Portal vein embolization (PVE) blocks blood flow to the liver lobe planned for removal, causing the other lobe to grow before surgery. PVE is used when a large tumour would leave too little liver behind. It adds weeks to the pathway but reduces postoperative liver failure risk in selected patients.

Kuo, Samra, and Hugh (2014) reviewed portal vein embolization prior to major liver resection in Australian practice, outlining patient selection and timing.

Thomas J. Hugh integrates PVE planning with oncologists when chemotherapy timelines also matter.

/ 03Evidence

How serious is bile leak after liver surgery?

Bile leak after liver surgery means bile escapes from the cut surface or a duct. ISGLS grades severity from minor drains to interventions. Most leaks settle with drainage and time; some need ERCP or reoperation. Prospective multicentre work including Hugh TJ (2015) evaluated routine drains and the ISGLS bile leak definition.

Knowing bile leak rates and grades helps patients interpret hospital course and discharge instructions.

Post-hepatectomy liver failure is a separate ISGLS outcome; Sultana et al. (2018) prospectively validated that definition across international centres with Hugh as co-author.

  • Prevention: careful surgical technique and selective drain use
  • Detection: drain output, bilirubin levels, CT if clinical concern
  • Treatment: endoscopic stenting, drainage, rarely reoperation
/ 04Evidence

What does HPB surgery in Sydney involve for patients?

HPB surgery Sydney pathways combine specialist surgeons, interventional radiology, and dedicated wards at major hospitals. Prehabilitation, nutrition, and cancer staging are completed before elective hepatectomy. Emergency liver surgery for trauma or bleeding follows different fast-track protocols.

Tom Hugh's 2019 Nature Reviews Clinical Oncology commentary with international colleagues stressed surgeons' role in oncology research, reflecting how HPB care links theatre outcomes to trials.

Yttrium-90 microsphere guidance co-authored by Hugh (2010) sits alongside resection for some liver cancers.

/ 05Evidence

How is recovery after hepatectomy managed?

After liver resection, most patients stay in hospital about five to ten days depending on extent and complications. Fatigue lasts weeks. Blood tests track liver function. Complications such as bile leak, bleeding, or infection extend recovery but are counted using the same ISGLS frameworks Hugh helped define.

Clear definitions improve transparency when Thomas J. Hugh discusses risks at St Leonards consultations.

/ 06Publications

Peer-reviewed publications by Thomas J. Hugh

The papers below are a selection of 66 papers from over 300 publications by Tom Hugh and collaborators, focused here on liver resection. Where a DOI or publisher link is available, it opens in a new tab so you can read the original research.
/ 07About the author

Who writes and operates from this evidence base?

Thomas J. Hugh is a specialist Upper GI and hepato-biliary surgeon and Chair of Surgery at the University of Sydney Northern Clinical School. He operates at Royal North Shore Hospital and North Shore Private, with consultations at the Tom Reeve Academic Surgical Clinic in St Leonards.

Outcomes across his practice are tracked through the DASO audit unit. That combination of published research and prospective audit is intended to keep advice grounded in measured results, not marketing claims.

Read more about Tom Hugh→
/ 08Common questions

Yes. The remaining liver hypertrophies over weeks, which is why portal vein embolization can prepare you for bigger operations.

Laparoscopic and robotic hepatectomy suit selected tumours and centres. Hugh's group contributes to international comparisons, including MIS versus open HCC series.

It is defined ISGLS criteria based on bilirubin and clotting after surgery. Hugh co-authored the original 2011 definition and later validation studies.

For metastases and some primary cancers, yes. Timing is individualised in tumour board meetings before hepatectomy is booked.

/ 09Related reading