Anatomical Hepatectomy Research Articles

Laparoscopic anatomical right hepatectomy for the treatment of advanced hepatocellular carcinoma(laennec approach combined with dorsal approach)

Laparoscopic anatomical right hepatectomy for the treatment of advanced hepatocellular carcinoma(laennec approach combined with dorsal approach)

Laennec\u2019s approach for laparoscopic anatomical hemihepatectomy

BackgroundLaennec’s capsule has been found for about 200 years. However, laparoscopic anatomical right and left hemihepatectomy (LARH and LALH) using Laennec’s approach are rarely reported.MethodsWe retrospectively analyzed the technical details and the surgical outcomes of 15 patients who underwent LAH via Laennec’s approach between May 2017 and July 2020. The operation time, intraoperative blood loss, postoperative complications, and hospital stay were recorded and analyzed.ResultsFour of 15 patients were diagnosed with hepatic hemangioma, 2 had hepatolithiasis, and 9 patients had primary liver cancer. During the surgery, Laennec’s approach was used for LAH without conversion to open surgery. Four patients were treated with LARH, and 11 patients were cured with LALH. The mean age of the patients was 62.1 ± 6.5 years, and four were male. The mean operative time, blood loss, and length of the postoperative hospital stay were 193 ± 49 min, 247 ± 120 mL, and 8.7 ± 2.0 days, respectively. There was no incidence of postoperative bile leakage and bleeding. No mortality occurred. We also demonstrated that Laennec’s capsule does exist around the peripheral hepatic veins with histological confirmation.ConclusionsLaennec’s approach is safe and feasible for LAH. Precise isolation of Laennec’s approach based on Laennec’s capsule helps to standardize the surgical techniques for laparoscopic anatomical hepatectomy.

Ultrasound-guided No Touch liver pedicle microwave ablation in hepatocellular carcinoma treatment

Abstract Objective This study aimed to investigate the feasibility, safety, and clinical effect of No Touch liver pedicle microwave ablation (NTLP-MWA). Methods The outcomes of 118 patients diagnosed with hepatocellular carcinoma (HCC) between 2014 and 2015 were retrospectively analyzed. Patients were divided into three groups. In group A, 35 patients underwent ultrasound-guided NTLP-MWA, 27 in Group B were treated with routine microwave ablation (RMWA), and 56 in group C underwent anatomic hepatectomy (AH). The preoperative basic data, intraoperative data, and postoperative data were analyzed among the three groups. Results The treatment time, intraoperative blood loss, and postoperative liver function (alanine transaminase) in the NTLP-MWA and RMWA groups were significantly different from those in the AH group (all P < 0.005). There was no difference in the complete elimination rate and local recurrence within 1 year among the three groups. Treatment was not an independent risk factor for early postoperative recurrence. There was no significant difference in the 5-year overall survival rates among the three groups. Conclusion NTLP-MWA is safe and reliable, in accordance with the principles of oncology treatment, and worth further promotion in clinical practice.

Predicting Post-Hepatectomy Liver Failure Using Intra-Operative Measurement of Indocyanine Green Clearance in Anatomical Hepatectomy.

Prediction of post-hepatectomy liver failure (PHLF) based on remnant liver function reserve is important for successful hepatectomy. The aim of this study was to investigate whether intraoperative indocyanine green (ICG) clearance in a future remnant liver was a predictor of PHLF. This prospective study enrolled 31 consecutive patients who underwent anatomical hepatectomy between June 2016 and August 2019. Intraoperative ICG plasma disappearance rate (ICG-PDR) and ICG retention rate at 15min (ICG-R15) were measured after clamping the selective hepatic inflow to the liver to be resected. The discriminative performance of the ICG-associated variables for the prediction of PHLF grade B/C was evaluated by receiver operator curve (ROC) analysis. Of the operations performed, 87.1% were major hepatectomy. PHLF Grade B/C was observed in eight patients (25.8%) with no mortality. The concordance indices of intraoperative ICG-PDR and ICG-PDR for predicting PHLF were 0.834 (95% CI, 0.69-0.98) and 0.834 (95% CI, 0.69-0.98), respectively. A subgroup analysis of patients with preoperative biliary drainage (BD) (n = 17) showed that the concordance indices of intraoperative ICG-PDR increased to 0.923 (95% CI, 0.79-1.00). Intraoperative ICG clearance in the remnant liver was a promising predictor for PHLF in patients undergoing anatomical hepatectomy, especially in patients with BD.

Initial experience of laparoscopic liver resection in a community hospital: A case-series

Laparoscopic major and anatomical hepatectomy is emerging as a preferred method to perform liver resection in recent decades. However, the role of laparoscopy remains a matter of development and has to be further evaluated. In Hong Kong, laparoscopic major and anatomical monosegmentectomy has been performing in tertiary centers with convincing outcomes. Aim of this study is to evaluate the feasibility and efficacy of laparoscopic major and anatomical liver resection to be established in a community hospital. It is a retrospective case series between Jan 2019-Dec 2020, 20 patients underwent laparoscopic major or anatomical liver resection in Yan Chai Hospital for various indications. There are 13 cases of hepatocellular carcinoma, 6 cases of intrahepatic choledocholithiasis, 1 case of colorectal liver metastasis. hemihepatectomy was performed in 11 cases with hilar dissection; while anatomical monosegmentectomy was performed in 9 cases with Glissonean pedicle approach. There was no 30 days mortality reported in our series. 3 cases required open conversions for difficult haemostasis by laparoscopic means. The average blood loss is 723 mL +/- 221 mL and 4 cases required intraoperative blood transfusion. The mean operative time was 325 minutes +/- 120 minutes. There are 7 cases of post-operative collection and 1 case requiring IR-guided drainage. The average length of stay was 10.35 days. Laparoscopic major and anatomical liver resection is safe and feasible in both tertiary and community center. Laparoscopic liver resection should be considered as an option whenever possible.

Parenchyma-sparing vessel-guided major hepatectomies: Nonsense or new paradigm?

Parenchyma-sparing vessel-guided major hepatectomies: Nonsense or new paradigm?

Short-term outcomes of anatomic right anterior liver sectionectomy for hepatocellular carcinoma with Glissonean pedicle approach

Hepatocellular carcinoma (HCC) is a common malignant disease in Vietnam with a high mortality rate. Anatomic right anterior liver sectionectomy is the prior choice for HCC which locates in this area if we can't perform right or central liver resection. The extrafascial approach are recognized as the Glissonean pedicle approach. When the Glissonean pedicles are ligated, anatomical hepatectomy area reveals. Forty-seven patients with diagnosis of HCC who underwent anatomic right liver anterior sectionectomy with Glissonean pedicle approach from March 2017 to March 2020 in our Department. Two techniques were used including extrafascial and extrafascial-transfissural approach (when the tumor locates near the right anterior glissonean pedicle). The mean age was 56.7 ± 11.82 year olds with male:female ratio is 10.75:1. Positive rates for hepatitis B is 74.5%. Selective control of Glissonean pedicle was successful in all cases: 35 cases (74.47%) with extrafasical approach and 12 cases (25.53%) with extrafascial-transfissural approach. There are 40 cases (85.1%) having intermittent clamping in a manner of 15minutes of ischemia and 5minutes of reperfusion repetitively and 7 cases (14.9%) having continuous hemihepatic vascular inflow clamping. The mean amount of intraoperative blood loss was 200 ± 120 mL and no transfusion. The mean operation time was 182.23 ± 54.07 minutes. The median postoperative hospital stay is 7.52 ± 2.25 days. No patients had necessity for blood transfusion. There was 1 case having liver failure and no mortality. Anatomic right anterior liver sectionectomy for HCC with Glissonean pedicle approach is feasible, safe, and effective procedure.

Laparoscopic and robotic volume preserving major hepatectomy

Transection along the right anterior fissure was proposed as a mechanism by which to open the third door of the liver for anatomical hepatectomy. Nowadays, laparoscopic anatomical liver resection is gaining momentum with less blood loss and shorter postoperative hospital stay. In this study, we sought to evaluate the feasibility, safety and potential benefits of laparoscopic assisted volume preserving major hepatectomy. Between October 2016 and December 2020, 76 patients underwent volume preserving major hepatectomy at the authors' institution. Except 3 patients underwent combined CBD resection, 45 patients underwent laparoscopic (42 patients) or robotic (3 patients) volume preserving major hepatectomy and 31 patients underwent open volume preserving major hepatectomy. Patient demographics and perioperative outcomes were analyzed and compared. There was no open conversion during laparoscopic procedure. There were no differences in operation time and length of hospital stay between laparoscopic assisted and open ventral segment preserving right hepatectomy. Patients who underwent laparoscopic procedure had less bleeding amount than those who underwent open procedure. Laparoscopic and robot volume preserving major hepatectomy is a feasible and safe procedure. However, more experience is essential to reveal the long term oncological results of volume preserving major hepatectomy.

Relationship between hepatic venous anatomy and hepatic venous blood loss during hepatectomy.

Predicting increased blood loss based on anatomical intervascular relationships is essential in major hepatectomy. We assessed 63 consecutive patients undergoing anatomical hepatectomy exposing the hepatic vein (HV) trunk at two institutes. Correlations between anatomical alterations of the hepatic inferior vena cava (IVC), HV, hepatic IVC, or right atrium (RA) and the blood loss per standard weight (BLSW) or blood transfusion (n = 18) were analyzed. The results of IVC partial clamping (PC) were additionally examined. The BLSW in type V-up anatomical morphology was significantly higher than that in straight type (p < 0.05). The parameters associated with an increased BLSW (> 13.5mL/kg) were tumor size (> 4cm), prothrombin activity (< 87%), CVP (> 7mmHg), area of suprahepatic IVC (< 360mm2), IVC-RA gap (> 28mm), longitudinal angle of IVC (< 160°), and axial angle of the MHV (< 55°). A multivariate analysis revealed that a high IVC-RA gap was a significant independent risk factor (odds ratio; 4.32, p < 0.05). Among 25 patients undergoing IVC-PC, only three showed a remarkable decrease in hepatic venous bleeding. No other statistically significant differences in the surgical records were observed in most cases. The IVC-RA gap might be a promising novel predictive parameter reflecting increased blood loss leading to blood transfusion in anatomical hepatectomy.

A Combined "Hanging Liver Maneuver" and "Intrahepatic Extra-Glissonian Approach" for Anatomical Right Hepatectomy: Technique Standardization, Results, and Correlation With Portal Pedicle Anatomy.

Background: The hanging liver maneuver and intrahepatic extra-Glissonian approach are distinct modalities to facilitate safe anatomical liver resections. This study reports a standardized combination of these techniques focusing on safety, results and correlation with portal pedicle anatomy in oncological patients.Method: Combined hanging liver maneuver and intrahepatic extra-Glissonian approach for anatomic right hepatectomy was described stepwise. Portal pedicle anatomy was correlated with the Glissonian approach failure and complications. Clinical characteristics of patients, perioperative outcomes, short and long-term survival rates were analyzed.Results: Thirty colorectal liver metastases patients submitted to the combined approach were evaluated. Anatomical variations of the right portal pedicle were present in 26.6%. Hanging liver maneuver was feasible in 100%, and Glissonian approach in 96.7% despite portal pedicle variations. Mean operative time was 326 min. Mean blood loss was 507 ml. Mean hospital stay was 8 days. There was no 90-day operative mortality and no significant morbidity. Oncological surgical margins were free. Overall and disease-free 5-year survival were 59 and 37%.Conclusion: Regardless of frequent anatomical variations of the right portal pedicle, the hanging liver maneuver, and intrahepatic extra-Glissonian approach can be combined, being useful for anatomical right hepatectomies in a safe and reproducible way in most patients.

Current status of radical laparoscopy for treating hepatocellular carcinoma with portal hypertension.

The laparoscopic technique is clinically effective in treating hepatocellular carcinoma (HCC) with portal hypertension (PHT). However, existing studies lack systematic arrangement and induction. Here, we review the latest research advancement in laparoscopic technique for treatment of HCC with PHT, based on published literature and our single-institution experience. Our single-center experience reveals no statistical difference in both short- and long-term prognosis of HCC patients after laparoscopic liver resection (LLR), regardless of whether they suffer from PHT, which is consistent with previous studies on the use of LLR for HCC with PHT. Retrieval outcomes indicate existence of short- and long-term prognostic superiority, following laparoscopic treatment, relative to non-laparoscopic treatment. Besides that, LLR offers long-term prognostic advantage compared to laparoscopic radiofrequency ablation. In addition, we review the previous literature and propose corresponding perspectives on the therapy of hypersplenism, the utilization of Pringle maneuver, and the adoption of anatomical hepatectomy during radical laparoscopic treatment. HCC with PHT is not the "forbidden zone" of radical laparoscopic treatment. However, patients’ preoperative liver function should be adequately estimated.

Actual long-term survival in hepatocellular carcinoma patients with microvascular invasion: a multicenter study from China.

Microvascular invasion (MVI) is a risk factor for postoperative survival outcomes for hepatocellular carcinoma (HCC) after liver resection (LR). This study aims to investigate the actual long-term survival and its associated prognostic factors after LR for HCC patients with MVI. This study was conducted on HCC patients with MVI who underwent LR from January 2009 to December 2012 at five major hospitals in China. The patients were divided into the 'long-term survivor group' and the 'short-term survivor group'. The clinicopathologic characteristics, perioperative data and survival outcomes were compared between these two groups. Univariate and multivariate regression analyses were performed to identify predictive factors associated with long-term survival outcomes. The study included 1517 patients with an actual 5-year survival rate of 33.3%. Multivariate regression analysis revealed that HBV DNA > 104IU/mL, alanine aminotransferase > 44 U/L, alpha-fetoprotein > 400ng/ml, anatomical hepatectomy, varices, intraoperative blood loss > 400ml, tumor diameter > 5cm, tumor number, satellite nodules, tumor encapsulation, wide resection margin and adjuvant transarterial chemoembolization (TACE) were independent prognostic factors associated with actual long-term survival. One-third of HCC patients with MVI reached the long-term survival milestone of 5years after resection. Anatomical hepatectomy, controlling intraoperative blood loss, a wide resection margin, and postoperative adjuvant TACE should be considered for patients to achieve better long-term survival outcomes.

Dorsal approach with Glissonian approach for laparoscopic right anatomic liver resections

BackgroundLaparoscopic anatomic hepatectomy (LAH) has gradually become a routine surgical procedure. However, how to expose the whole hepatic vein and avoid the hepatic vein laceration is still a challenge because of the caudate lobe, particularly in right hepatectomy. We adopted a dorsal approach combined with Glissionian appraoch to perform laparoscopic right anatomic hepatectomy (LRAH).MethodsTwenty patients who underwent LRAH from January 2017 to November 2018 were retrospectively analysed. Of these patients, seven patients underwent laparoscopic right hemihepatectomy (LRH group), seven patients who underwent laparoscopic right posterior hepatectomy (LRPH group), and six patients who underwent laparoscopic hepatectomy for segment 7 (LS7 group). The paracaval portion of caudate lobe could be transected firstly through dorsal approach and the corresponding major hepatic vein could be exposed from its root to the peripheral branches safely. Due to exposure along the major hepatic vein trunk, the remaining liver parenchyma could be quickly transected from dorsal to cranial side.ResultsThe mean age of the patients was 53.8 years and the male: female ratio was 8:12. The median operation time was 306.0 ± 58.2 min and the mean estimated volume of blood loss was 412.5 ± 255.4 mL. The mean duration of postoperative hospital stay was 10.2 days. The mean Pringle maneuver time was 64.8 ± 27.7 min. Five patients received transfusion of 2–4 U of red blood cells. Two patients suffered from transient hepatic dysfunction and one suffered from pleural effusion. None of the patients underwent conversion to an open procedure. The operative duration, volume of the blood loss, Pringle maneuver time, and postoperative hospital stay duration did not differ significantly among the LRH, LRPH, and LS7 groups (P > 0.05).ConclusionsDorsal approach combined with Glissonian approach for right lobe is feasible and effective in laparoscopic right anatomic liver resections.

Augmented Reality Navigation for Stereoscopic Laparoscopic Anatomical Hepatectomy of Primary Liver Cancer: Preliminary Experience.

BackgroundAccurate determination of intrahepatic anatomy remains challenging for laparoscopic anatomical hepatectomy (LAH). Laparoscopic augmented reality navigation (LARN) is expected to facilitate LAH of primary liver cancer (PLC) by identifying the exact location of tumors and vessels. The study was to evaluate the safety and effectiveness of our independently developed LARN system in LAH of PLC.MethodsFrom May 2018 to July 2020, the study included 85 PLC patients who underwent three-dimensional (3D) LAH. According to whether LARN was performed during the operation, the patients were divided into the intraoperative navigation (IN) group and the non-intraoperative navigation (NIN) group. We compared the preoperative data, perioperative results and postoperative complications between the two groups, and introduced our preliminary experience of this novel technology in LAH.ResultsThere were 44 and 41 PLC patients in the IN group and the NIN group, respectively. No significant differences were found in preoperative characteristics and any of the resection-related complications between the two groups (All P > 0.05). Compared with the NIN group, the IN group had significantly less operative bleeding (P = 0.002), lower delta Hb% (P = 0.039), lower blood transfusion rate (P < 0.001), and reduced postoperative hospital stay (P = 0.003). For the IN group, the successful fusion of simulated surgical planning and operative scene helped to determine the extent of resection.ConclusionsThe LARN contributed to the identification of important anatomical structures during LAH of PLC. It reduced vascular injury and accelerated postoperative recovery, showing a potential application prospects in liver surgery.

Indocyanine green fluorescence imaging-guided laparoscopic right posterior hepatectomy.

Laparoscopic right posterior hepatectomy is considered difficult on the basis of the surgery difficulty scoring system. In this study, we evaluated the safety and effectiveness of the technical application of indocyanine green (ICG) fluorescence imaging-guided laparoscopic right posterior hepatectomy. Twenty-six patients who underwent ICG fluorescence imaging-guided laparoscopic right posterior hepatectomy at Hepatobiliary and Pancreatic Surgery Department of Zhongnan Hospital, Wuhan University, from June 2018 to December 2019, were included. The influence of patient position, trocar placement, hepatic inflow occlusion, central venous pressure (CVP), and the ICG fluorescence imaging-guided method were analyzed. In 17 patients, the left lateral position was maintained when the main tumor was in the S7, and in the remaining nine patients, the supine position was maintained with the right side of the body raised when the main tumor was in the S6. Ten patients who underwent preoperative injection of ICG were successfully developed for nonanatomical hepatectomy. Sixteen patients received intraoperative ICG injection for anatomical hepatectomy (2 cases had positive imaging findings, 14 cases had negative imaging findings, and 2 cases had failed imaging findings). All patients underwent the Pringle maneuver during the procedure. Four patients were preset with subhepatic vena cava blocking and one patient with suprahepatic inferior vena cava blocking. CVP was controlled at 3.00 ± 0.63 (mean ± SD) cmH2O. The operative time was 216.14 ± 52.05min, and the bleeding volume was 128.57 ± 75.55ml. Four patients had Clavien-Dindo level I complications, and one had level III complications. Postoperative hospitalization duration was 6.19 ± 1.40days. There were 14 patients with hepatocellular carcinoma, 9 with metastatic liver malignancies, 2 with hepatic hemangioma, 1 with focal nodular hyperplasia of the liver, and 10 with hepatitis B liver cirrhosis. ICG fluorescence imaging guidance could be helpful for the safe implementation of laparoscopic right posterior hepatectomy.

Improved Mortality, Morbidity and Long-Term Outcome after Anatomical Hepatectomy with the Glissonean Pedicle Approach in Patients with Hepatocellular Carcinoma: 30 Years Experience at TWMU

Background: We evaluated the morbidity and mortality after anatomical hepatectomy with the glissonean pedicle approach, and attempted to clarify whether there might be differences in long-term outcomes in relation to the morbidity in patients with hepatocellular carcinoma (HCC). Methods: Anatomical hepatectomy with the glissonean pedicle approach was developed in 1984. 1953 patients with HCC underwent various anatomical hepatectomies between 1985 and 2014. The morbidity (Clavien-Dindo class IIIa or more) and mortality (30-day and 90-day) were evaluated among six 5-year eras (1985-1989, 1990-1994, 1995-1999, 2000-2004, 2005-2009, 2010-2014). Results: 460 patients (24%) showed morbidity after hepatectomy. The overall 30-day and 90-day mortality rates were 1.7% and 3.6%, respectively. Blood loss >2L (45%, 34%, 33%, 17%, 14%, 8%: p< 0.0001) and bile leakage (29%, 15%, 19%, 11%, 13%, 7%: p< 0.0001), and morbidity (41%, 23%, 28%, 17%, 20%, 14%: p< 0.0001) were decreased gradually over the eras. 30-day (3.9%, 3.0%, 1.8%, 1.3%, 0.3%, 0.5%: p=0.0074) and 90-day mortality (7.8%, 4.3%, 3.8%, 2.8%, 2.2%, 1.4%: p=0.0036) were significantly improved over the eras. Blood loss >2L (p= 0.0244) was an independent risk factor for 30-day mortality, and blood loss >2L (p=0.0271) and bile leakage (p=0.0078) were independent risk factors for 90-day mortality on multivariate analysis. Bile leakage (p=0.004) and morbidity (p< 0.0001) were significant independent prognostic factors for overall survival in patients with HCC. Conclusions: Anatomical hepatectomy with the glissonean pedicle approach was achieved safely in patients with HCC. For more safety and longer survival, blood loss, bile leakage, and morbidity should be reduced.

Origin Regression in Right Anatomical Hepatectomy for 70 Years

Right anatomical hepatectomy (RH) is a standard procedure for liver malignancies and its history is quite fascinating.To understand origin and concept such as pioneers, development of procedures and future aspects of RH, we attempted to review the “hidden” history worldwide since 1945 by searching not only English but also non-English published documents, and international experts' comments. In RAH, anatomical concept and identification, vascular control technique, approaches, preoperative managements are considered to be important issues. Basis of the modern liver anatomy has been clarified in French article by Tung (Vietnam) and Meyer-May in 1939, who applied to liver anatomical resection thereafter. Who was a pioneer? Honjo in 1949 and Jacob in 1951 succeeded RH in 1941 and 1951 in each, which were published in Japanese and French, respectively. This is a begging of RH and RH has began to spread as the surgical treatment of liver malignancies worldwide since then. Vascular in-flow control is divided as intrafascial, extrafascial or transfissual access. The anatomical border along the main hepatic veins was clarified for transection according to establishment of liver anatomy. Anterior approach were proposed as an alternative option in the hazardous situations of right liver rotation. Hanging maneuver for anterior approach has been developed for various anatomical hepatectomies. Laparoscopic or robotic new technology provides patient´s benefit even in RH. Thus,understanding origin sources regarding RH established for 70 years is quite necessary for liver surgeons. Future aspects of RH will include changes of concepts, new technology to ensure patient safety and disease curability.

Curative Hepatectomy for Todani Type IV-A Biliary Dilatation(BD) in Adults: Removal of Cystic Dilatation and Biliary Stricture

Introduction: There is no universal surgical strategy for patients with Todani type IV-A BD. Traditionally, excision of the extrahepatic cyst with hepaticojejunostomy is the standard procedure, but long-term outcome is not satisfactory. This study aimed to analyze postoperative and long-term outcomes of a consecutive series of patients undergoing curative hepatectomy for Todani type IV-A BD. Patients and method: All patients who underwent hepatectomy for Todani type IV-A BD in adults during 2007 to 2017 were retrospective analyzed at high-volume centers. Patients were divided into two groups, A: re-operation group who had previous surgery, B: operation group who received initial surgical treatment. Two principles were used in this study. One is radical but conservative hepatectomy and the other type of surgery was based on the anatomical level of diseased bile duct. Segmental BD was removed by anatomical hepatectomy. Results: There were 117 patients enrolled, 66 in group A and 51 in group B. Hepatectomy was performed in 63 and 43 patients in group A and B, respectively. Local BD excision in hepatic hilum was performed in 3 and 8 patients (P = 0.084), while radical resection of cystic dilatation of intrahepatic bile ducts was achieved in 60 and 48 patients, respectively. Postoperative morbidity, but not mortality in group A, was significantly higher. Conclusion: Based on the morphological feature and anatomical level of intrahepatic BD, the strategy of radical but conservative hepatectomy is safe and effective for the treatment of complex Todani type IV-A BD in adults.

Clinical Observation of Laparoscopic Anatomic Hepatectomy for Early Primary Liver Cancer

At present, liver resection is the most effective treatment for malignant liver tumors, and with the rapid development of medical technology, anatomical liver resection has been widely used in clinical practice. This paper mainly studies the clinical effect of laparoscopic anatomic hepatectomy in the treatment of early primary liver cancer. According to the surgical method, the patients were divided into anatomic and non-anatomic hepatectomy groups. Preoperative, intraoperative and postoperative efficacy data of the two groups were analyzed. According to the clinical results, the anatomical resection of liver cancer has short operation time, fewer postoperative complications, fast recovery of liver function, and long survival time without tumor, with obvious clinical effect and definite curative effect, which is worthy of promotion.

Laparoscopic Parenchyma-sparing Liver Resection for Large Colorectal Cancer Metastases

Background: Traditionally, patients with large liver tumors have been considered for anatomic major hepatectomy. Laparoscopic resection of large liver lesions is technically challenging and often performed by surgeons with extensive experience. The aim of the current study was to evaluate the surgical and oncologic safety of laparoscopic parenchyma-sparing liver resection in patients with large colorectal metastases.