Liver Resection Strategies and Outcomes

Liver resection remains the principal curative approach for a range of primary and secondary hepatic malignancies, as well as certain benign tumours. Surgical strategies have evolved to balance maximal tumour clearance with preservation of functional liver parenchyma and minimisation of perioperative risk. Techniques such as pedicle clamping, segmental or anatomical resections, and the use of minimally invasive approaches are deployed in accordance with tumour location, liver quality and patient comorbidities. Outcomes are shaped by intraoperative blood loss, ischaemia–reperfusion injury and postoperative liver function, with long-term survival hinging on recurrence risk and remnant liver regeneration. Recent innovations, including selective vascular exclusion and optimised perioperative pharmacological strategies, seek to reduce complications and improve both short- and long-term prognosis. Multidisciplinary planning, advanced imaging and real-time assessment of liver viability now underpin personalised surgical care, with global data demonstrating steady improvements in mortality and morbidity over the past decade.

Research from Nature Portfolio

Recent meta-analytical work has clarified the long-term oncological impact of hepatic pedicle clamping during resections for primary or metastatic liver tumours. Aggregated data from randomised and non-randomised studies indicate that intermittent application of inflow occlusion does not compromise one-, three- or five-year overall survival or recurrence-free survival. These findings support the continued use of pedicle clamping to reduce operative blood loss without adversely affecting long-term tumour outcomes. Moreover, analyses reveal that judicious timing and duration of occlusion are key to balancing haemostatic benefit against potential ischaemic injury.

Liver Resection Strategies and Outcomes publication trend

The graph below shows the total number of articles in liver resection strategies and outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Hepatectomy: Surgical removal of a portion of the liver, ranging from wedge resection to major anatomical lobectomy.

Pringle manoeuvre: Temporary clamping of the hepatic pedicle to control bleeding by occluding portal triad inflow.

Selective hepatic vascular exclusion: Targeted occlusion of inflow and outflow vessels supplying a specific liver segment or lobe to minimise global ischaemia.

Ischaemia–reperfusion injury: Tissue damage caused when blood supply returns to the liver after a period of oxygen deprivation during vascular clamping.

References

1. Effects of perioperative steroid use on surgical stress and prognosis in patients undergoing hepatectomy: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Pharmacology (2024).
2. Meta-analysis of the effect of the pringle maneuver on long-term oncological outcomes following liver resection. Scientific Reports (2021).
3. Selective Hepatic Vascular Exclusion versus Pringle Maneuver in Major Hepatectomy: A Systematic Review and Meta-Analysis. Frontiers in Surgery (2022).
4. Glucocorticoid use and ischemia‐reperfusion injury in laparoscopic liver resection: Randomized controlled trial. Annals of Gastroenterological Surgery (2019).