Recently, the treatment of liver lesions has evolved from limited treatment options to effective therapeutic alternatives. Among therapeutic options, extended liver resection can now be performed safely with minimal mortality and low morbidity. New techniques, such as enucleation or cryoablation, are available where parenchymal-sparing procedures are needed. In addition, other interventions, such as hepatic artery embolization of tumors and, in some cases, portal vein embolization of a lobe or more, have allowed preoperative downstaging of some tumors and the remodeling of nontumoral hepatic parenchyma in anticipation of major resection. An accurate diagnosis and precise determination of the extent of disease are, therefore, essential.

This article reviews the segmental anatomy of the liver, which is the basis of modern hepatic surgery. Liver regeneration and the factors affecting liver volumes and the pathophysiology of the atrophy-hypertrophy complex are discussed. Benign and malignant focal liver lesions are reviewed from a surgeon's perspective. Finally, an imaging strategy is proposed and the treatment options outlined.