Precision surgery for primary liver cancer

Abstract

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.

Anatomical Resection Improved the Outcome of Intrahepatic Cholangiocarcinoma: A Propensity Score Matching Analysis of a Retrospective Cohort

“…Multivariate analysis identified NAR, tumor size >5 cm, multiple tumors, and poor differentiation as Primary liver cancer is the fifth most commonly diagnosed malignancy worldwide, with a high prevalence in Asia and Africa. HCC arising from hepatocytes and ICC from bile duct epithelium are major types of primary liver cancer [31,32]. ICC is located in the second-order bile ducts in the hepatic parenchyma, extinguished with pCCA in left and right common hepatic ducts and dCCA in common bile duct [33].…”

Short- and Long-Term Outcomes of Indocyanine Green Fluorescence Navigation- Versus Conventional-Laparoscopic Hepatectomy for Hepatocellular Carcinoma: A Propensity Score-Matched, Retrospective, Cohort Study

“…The criteria for anatomical hepatectomy are technically defined as follows: marking the border of the liver segment on the liver surface by staining or ischemia line; ultrasound-guided liver parenchyma cutting with the landmark vein of the liver segment as the border; exposure of all veins of significance; and ligation of the Glisson system near the root of the liver segment. 24 , 25 …”

“…The criteria for anatomical hepatectomy are technically defined as follows: marking the border of the liver segment on the liver surface by staining or ischemia line; ultrasound-guided liver parenchyma cutting with the landmark vein of the liver segment as the border; exposure of all veins of significance; and ligation of the Glisson system near the root of the liver segment. 24,25 The imaging equipment was the Canadian Pinpoint Novadaq laparoscopic fluorescence imaging system, which uses LED visible light and near-infrared dual light sources and cooperates with the fluorescent contrast agent to display endoscopic images. The system provides three imaging modes: high-definition natural light view, black and white view, and green fluorescence view.…”

Enhanced Recognition Confidence of Millimeter‐Sized Intrahepatic Targets by Real‐Time Virtual Sonography

“…P recision liver surgery requires profound tacit knowledge of detecting liver tumors, keeping the planned liver transection plane, and distinguishing intrahepatic vasculatures to be cut or reserved. 1 The advanced medical image processing technology, integrated into three-dimensional (3D) simulation software, 2,3 enabled more precise surgical planning in liver surgery. However, liver surgeons often find difficulty in realizing a surgical plan, especially in performing precisely a complex liver resection, Video online at jultrasoundmed.org Supplemental material online at jultrasoundmed.org such as multiple limited resections or small anatomical resections.…”

“…Precision liver surgery requires profound tacit knowledge of detecting liver tumors, keeping the planned liver transection plane, and distinguishing intrahepatic vasculatures to be cut or reserved 1 . The advanced medical image processing technology, integrated into three‐dimensional (3D) simulation software, 2,3 enabled more precise surgical planning in liver surgery.…”