Hepatic Resection Techniques for Hepatocellular Carcinoma

Hepatic resection remains a cornerstone in the curative treatment of hepatocellular carcinoma, aiming to achieve complete tumour clearance while preserving sufficient functional liver parenchyma. Techniques range from anatomical resections—segmentectomy, lobectomy and central resections—to non-anatomical wedge excisions, with the choice informed by tumour size, location, liver function and remnant volume. Parenchymal-sparing approaches such as mesohepatectomy and central bisectionectomy have evolved to maintain future liver remnant, reduce postoperative liver failure and allow for potential re-resection. Vascular control manoeuvres, including intermittent portal triad clamping (Pringle manoeuvre) and infra-hepatic inferior vena cava clamping, alongside intraoperative ultrasound and cavitron ultrasonic surgical aspiration, have refined transection precision and minimised blood loss. The advent of laparoscopic and robotic platforms has further advanced minimally invasive hepatectomy, offering shorter hospital stays and expedited functional recovery without compromising oncological outcomes. Continuous refinements serve global needs in regions with high disease burden and organ shortages, reinforcing resection as a vital strategy for long-term survival and repeat intervention.

Research from Nature Portfolio

Recent meta-analytic evidence indicates that mesohepatectomy provides equivalent overall and disease-free survival to extended hemihepatectomy for centrally located hepatocellular carcinomas, while preserving a larger future liver remnant. This parenchymal-sparing approach reduces the risk of post-hepatectomy liver failure, shows favourable intraoperative blood loss and operation times, and supports repeat resections in the event of recurrence. Although bile leakage rates may be slightly elevated, the balance of oncological safety and functional preservation underscores mesohepatectomy as a viable standard for selected central tumours.

Hepatic Resection Techniques for Hepatocellular Carcinoma publication trend

The graph below shows the total number of articles in hepatic resection techniques for hepatocellular carcinoma across all publications each year (not limited to Nature Index journals).

Technical terms

Anatomical resection: Removal of liver tissue based on the Couinaud segmental anatomy to ensure complete excision of tumour-bearing portal territories.

Mesohepatectomy: Central liver resection removing segments 4, 5 and 8 to treat mid-liver tumours while preserving peripheral lobes.

Extended hemihepatectomy: Resection of one hepatic lobe plus additional segments to achieve wider oncological margins.

Laparoscopic hepatectomy: Minimally invasive liver resection performed through small incisions using video-guided instruments.

Future remnant liver volume: Proportion of healthy liver parenchyma remaining post-resection, critical for maintaining postoperative function.

Post-hepatectomy liver failure: A clinical syndrome of impaired liver function after resection, characterised by coagulopathy and hyperbilirubinaemia.

References

1. Risk Factors of Complications from Central Bisectionectomy (H458) for Hepatocellular Carcinoma: A Multi-Institutional Single-Arm Analysis. Cancers (2023).
2. Asia-Pacific multicentre randomized trial of laparoscopic versus open major hepatectomy for hepatocellular carcinoma (AP-LAPO trial). BJS Open (2023).
3. Mesohepatectomy Versus Extended Hemihepatectomies for Centrally Located Liver Tumors: A Meta-Analysis. Scientific Reports (2017).
4. Central hepatectomy versus major hepatectomy for patients with centrally located hepatocellular carcinoma: a systematic review and meta-analysis. BMC Surgery (2023).