Precision surgery for primary liver cancer

Liver resection remains the best curative option for primary liver cancer, such as hepatocellular carcinoma(HCC) and intrahepatic cholangiocarcinoma.In particular, in liver resection for HCC, anatomical resection of the tumor-bearing segments is highly recommended to eradicate the intrahepatic metastases spreading through portal venous branches.Anatomical liver resection,including anatomical segmentectomy and subsegmentectomy using the dye-injection method, is technically demanding and requires experience for completion of a precise procedure.The recent development of imaging studies and new computer technologies has allowed for the preoperative design of the operative procedure, intraoperative navigation, and postoperative quality evaluation of the anatomical liver resection.Although these new technologies are related to the progress of artificial intelligence, the actual operative procedure is still performed as human-hand work.A precise anatomical liver resection still requires meticulous exposure of the boundary of hepatic venous tributaries with deep knowledge of liver anatomy and utilization of intraoperative ultrasonography.

Left hepatic trisectionectomy for perihilar cholangiocarcinoma with a right-sided round ligament:A case report

BACKGROUND A right-sided round ligament(RSRL)is a rare,congenital anomaly of the intrahepatic portal vein,with a reported frequency of 0.2%-1.2%.For patients with perihilar cholangiocarcinoma associated with an RSRL,an accurate understanding of the vascular and biliary anatomy is indispensable.CASE SUMMARY We report a 70-year-old male with perihilar cholangiocarcinoma associated with an RSRL.After percutaneous transhepatic embolization of the left and anterior portal branches,we conducted a left trisectionectomy of the liver with extrahepatic bile duct resection and hepaticojejunostomy.The postoperative course was uneventful,and R0 resection was achieved.When the liver volume of each section was compared between 7 patients with an RSRL and 20 patients with normal portal vein anatomy,the posterior section in RSRL patients was significantly larger than that in patients with normal portal vein anatomy(median:457 mL vs 306 mL,P=0.031).In patients with perihilar cholangiocarcinoma associated with an RSRL,left trisectionectomy has several surgical advantages:(1)The posterior branch of the portal vein often ramifies independently,and the division of the portal vein is easily conducted;(2)A relatively large amount of remnant liver can be retained;and(3)The anatomy of the posterior branch of the Glissonian pedicle is similar to that in patients with normal anatomy.CONCLUSION In patients with an RSRL and perihilar cholangiocarcinoma that does not involve the posterior section,left trisectionectomy may be a favorable choice.

Improvement and development in anatomical hepatectomy for hepatocellular carcinoma

Liver resection is one of the best practical curative options for hepatocellular carcinoma(HCC).Since HCC spreads via portal venous system(1,2)and develops intrahepatic metastases,resecting tumor-bearing territory,so-called anatomical resection,is proven to provide higher curability than non-anatomical limited liver resection(3).