ASO Author Reflections: Laparoscopic Anatomic Portal Territory Hepatectomy: A Trend Toward a Personalized Liver Surgery

Excerpt

Hepatocellular carcinoma (HCC) accounts for nearly 90% of primary liver malignancy cases and is consistently the third leading cause of cancer-related death worldwide.1 Practice guidelines have recommended surgical resection as the primary option for HCC in the early stage.1^,2 In recent years, anatomic liver resection (AR) has been widely accepted because it completely removes both the tumor and the corresponding segments supplied by the tumor-bearing portal vein, conforming to the radical nature of oncology.3 On the other hand, minimally invasive surgery, represented by laparoscopic resection, has been another development trend in the liver surgical field. However, the traditional AR strategy of puncturing into the portal vein and injecting methylene blue guided by intraoperative ultrasound (IOUS) is a quite tricky operation in laparoscopy. As a result, laparoscopic AR remains a highly specialized procedure. Moreover, many variations of Glissonean pedicel distribution have been discovered, leading to the question of what is truly AR. In the authors’ view, every single patient has his or her personalized liver anatomy. A true AR requires making a specific surgical plan according to patient-specific anatomy instead of blindly referring to Couinaud segments. …