Concept and practice of laparoscopic limited anatomical hepatectomy / 中华消化外科杂志

ABSTRACT

Laparoscopic anatomic hepatectomy has become one of the therapeutic measures for hepatocellular carcinoma (HCC), which has been proven to bring both minimally invasive and survival benefits to patients from both surgical and oncological perspectives. More than 80% of HCC patients in China are complicated with cirrhosis, and the liver reserve function is impaired. Tumors often grow across liver segments or involve multiple segments. However, the application of tradi-tional laparoscopic anatomic hepatectomy is limited due to the large volume of liver resection, which is prone to lead to postoperative liver failure. Based on the bio-oncological characteristics of HCC and the limitations of traditional laparoscopic anatomical hepatectomy, the concept and practice of laparoscopic limited anatomical hepatectomy (LLAH) came into being. LLAH, also known as hepatic parenchyma-preserving anatomical hepatectomy, is based on the tumor lesion as the center, the portal territory with tumor as the reference plane, and anatomical relationship between tumor location and the sub-hepatic segment or hepatic segment as the principle to remove the tumor and its subsegment or hepatic segmental portal territory. Its core concept is to maximize the preser-vation of functional liver parenchyma on the premise of ensuring oncological resection. The main surgical procedures of LLAH include anatomical subsegmental resection, segmentectomy and combined subsegmental/segmental resection with preservation of liver parenchyma. Its main indica-tion is small or micro hepatocellular carcinoma located between subsegments/segments. Navigation technologies such as three-dimensional visualization, laparo-scopic ultrasound, and indocyanine green fusion fluorescence are used to achieve anatomical hepatectomy with tumor and its oncolo-gical safety margin as the center through the splicing and combination of multiple subsegments/segments. The purpose of resection of the liver tissue in the portal territory with tumor and preser-vation of the functional liver structure and volume are achieved to the maximum extent after LLAH. At present, LLAH for HCC is still in the exploratory stage, and its long-term oncology results need to be further studied. However, with technological progress and concept update, LLAH will surely become the core method for minimally invasive and precise treatment of HCC. Combined with related researches at at home and abroad, the authors describe the concept and development, theoretical and technical supports, oncological safety and development trends of LLAH.