Surgical management of liver diseases requires excellent knowledge of regional anatomy, specialized technique, and proficiency in switching between traditional surgical methods and modern technological advancements. This vital organ of the human body is affected by both benign and malignant conditions.

Primary Neoplasms: The most common primary liver neoplasm is hepatocellular carcinoma. Key predisposing factors include cirrhosis, mainly of alcoholic etiology, and chronic infection with hepatitis B or C. Nowadays, non-alcoholic steatohepatitis, primarily due to obesity, is an increasingly significant risk factor. The second most common primary liver tumor is cholangiocarcinoma, which develops either in the intrahepatic or extrahepatic bile ducts, with main predisposing factors being chronic inflammatory disorders of the liver and bile ducts.

Secondary Neoplasms: The liver is one of the most frequent sites for metastases from other cancers. These can be synchronous, appearing simultaneously or shortly after the diagnosis of the primary tumor, or metachronous, occurring long after the initial treatment of the primary tumor. The most common malignancy metastasizing to the liver is colorectal cancer, followed by other malignancies such as breast cancer, pancreatic cancer, and neuroendocrine tumors.

Benign Conditions: The liver can present with multiple lesions, which may be malignant, benign, or of uncertain neoplastic potential. Some of the most frequent include liver cysts, which can be simple or parasitic (echinococcal), hemangiomas, and lesions such as focal nodular hyperplasia and hepatic adenomas.

Management: Management of liver diseases, particularly malignant neoplasms, requires collaboration among multiple specialties within the framework of an oncology board. The goal is to ensure the optimal sequence of therapeutic interventions, especially in the case of liver metastases, adequate oncological treatment, and assessment of hepatic reserve. Benign liver lesions are treated based on size, location, and presence of symptoms. Surgical procedures include metastasectomy, atypical hepatectomy, and standard hepatectomy, which involve removal of specific liver segments or lobes. Finally, for symptomatic simple liver cysts, laparoscopic deroofing of the cyst is the surgical method of choice.