Precise hepatectomy in the intelligent digital era

Abstract

In the past 20 years, the concept of surgery has undergone profound changes. Surgical practice has shifted from emphasizing the complete elimination of lesions to achieving optimal rehabilitation in patients. Collaborative optimization of surgery consists of three core elements, removal of lesions, organ protection and injury close monitoring, and controlled surgical intervention. As a result, the traditional surgical paradigm has quietly transformed into a modern precision surgical paradigm. In this review, we summarized the latest breakthroughs and applications of precision medicine in liver surgery. In addition, we also outlined the progresses that have been made in precision liver surgery, the opportunities and challenges that may encountered in the future.

Safety and efficacy of precision hepatectomy in the treatment of primary liver cancer

“…Precise surgical operation means that on the basis of precise pre-operative assessment and sophisticated surgical planning, the operation is carried out according to a previously drawn up plan, with a delicate operation that presupposes radical resection, grasps the concept of minimal invasion, minimizes unnecessary tissue damage and applies advanced techniques to control intraoperative bleeding [ 6 , 22 ]. Especially for complex liver resections.…”

“…How to improve the resection rate of primary liver cancer remains a hot topic of clinical research. Precision hepatectomy is a new concept and technical system for the treatment of liver cancer, pursuing the ideal goal of minimizing invasion and maximizing liver protection and obtaining the best recovery outcome, and accurate assessment of the liver before surgery is particularly important [ 6 , 7 ]. In recent years, 3D reconstruction techniques have been increasingly used in primary liver cancer patients, but there are few clinical studies on precision hepatectomy guided by 3D reconstruction techniques in primary liver cancer [ 8 ].…”

Efficacy evaluation and prognostic risk factors analysis of precise hepatectomy in the treatment of intermediate and advanced hepatocellular carcinoma

“…Preoperative evaluation includes evaluating whether the tumor could be completely removed while ensuring sufficient residual liver function, mapping the precise individual liver structure, and making plan B for unexpected reconstruction [16]. In this trial, contrast-enhanced ultrasonography was completed, simulated hepatectomy residual liver volume measurement was calculated, and CT three-dimensional angiography was constructed before precise hepatectomy [20]. Combined with the intraoperative gentle operation, the damage of the liver resection was reduced, and the precision was improved.…”

Two novel online nomograms for predicting the survival of individual patients undergoing partial hepatectomy for huge hepatocellular carcinoma

“…Additionally, both centers routinely used intraoperative ultrasonography to further ascertain the boundary and contiguity of the tumor, which was consistent with the concept of precise hepatectomy. 30,31 Pathologic specimens were reviewed for tumor size, tumor differentiation, satellite focus, vascular invasion and microscopic margin.…”