The difficulties and countermeasures of laparoscopic hepatectomy in the treatment of hepatocellular carcinoma in the difficult sites of liver_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHENG Bowen ,  ZHENG Shuoguo

The Institute of Hepatobiliary Surgery of the Army, First Affiliated Hospital, Army Medical University, Chongqing, 400038, P. R. China;

Corresponding author：

ZHENG Shuoguo, Email: shuguozh@163.com

Keywords：

laparoscopy; hepatectomy; hepatocellular carcinoma; difficult sites of liver

DOI：

10.7507/1007-9424.202410096

Video：

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Laparoscopic hepatectomy is routinely used in the surgical treatment of hepatocellular carcinoma, and has formed a standardized operating procedure. Tumors located in the segments Ⅶ and Ⅷ of liver as well as the paracaval subsegment of caudate lobe are considered to be difficult sites for laparoscopic hepatectomy due to the deep anatomical location, proximity to important vascular structures, difficulty in exposing the visual field under laparoscopy, and limited operating space. Based on the experience of our team and related research reports, the authors analyzed and summarized countermeasures for the difficulties of laparoscopic hepatectomy in the treatment of hepatocellular carcinoma in difficult sites. Adhering to the tumor-centered and margin-based principles, accurate preoperative assessment, selection of the correct surgical approach, designing liver resection plane guided by hepatic vena while taking into account portal vein territory, and giving preference to ananatomical hepatectomy while preserving functional liver parenchyma as much as possible are the prerequisites for ensuring minimally invasive and oncology benefits for patients with hepatocellular carcinoma in difficult sites.

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2.	Wang Q, Li HJ, Dai XM, et al. Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: Systematic review and meta-analysis of propensity-score matched studies. Int J Surg, 2022, 105: 106821. doi: 10.1016/j.ijsu.2022.106821.
3.	Buell JF, Cherqui D, Geller DA, et al. The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg, 2009, 250(5): 825-830.
4.	Wakabayashi G, Cherqui D, Geller DA, et al. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg, 2015, 261(4): 619-629.
5.	陈孝平, 张万广. 中国腹腔镜肝癌手术20年回顾与展望. 中华普外科手术学杂志(电子版), 2021, 15(4): 355-358.
6.	俞巍, 张洪义, 邢颖, 等. 肝脏恶性肿瘤术前肝功能评估和影像学评估. 中国临床医生杂志, 2022, 50(5): 512-516.
7.	Liao K, Yang K, Cao L, et al. Laparoscopic anatomical versus non-anatomical hepatectomy in the treatment of hepatocellular carcinoma: a randomised controlled trial. Int J Surg, 2022, 102: 106652. doi: 10.1016/j.ijsu.2022.106652.
8.	Moris D, Tsilimigras DI, Kostakis ID, et al. Anatomic versus non-anatomic resection for hepatocellular carcinoma: A systematic review and meta-analysis. Eur J Surg Oncol, 2018, 44(7): 927-938.
9.	Feng X, Su Y, Zheng S, et al. A double blinded prospective randomized trial comparing the effect of anatomic versus non-anatomic resection on hepatocellular carcinoma recurrence. HPB (Oxford), 2017, 19(8): 667-674.
10.	Berardi G, Igarashi K, Li CJ, et al. Parenchymal sparing anatomical liver resections with full laparoscopic approach: description of technique and short-term results. Ann Surg, 2021, 273(4): 785-791.
11.	Zhu P, Liao W, Zhang WG, et al. A prospective study using propensity score matching to compare long-term survival outcomes after robotic-assisted, laparoscopic, or open liver resection for patients with BCLC stage 0-A hepatocellular carcinoma. Ann Surg, 2023, 277(1): e103-e111. doi: 10.1097/SLA.0000000000005380.
12.	Tian F, Leng S, Chen J, et al. Long-term outcomes of laparoscopic liver resection versus open liver resection for hepatocellular carcinoma: A single-center 10-year experience. Front Oncol, 2023, 13: 1112380. doi: 10.3389/fonc.2023.1112380.
13.	郑博文, 郑树国. 腹腔镜解剖性肝切除术治疗肝细胞癌的现状与思考. 肝癌电子杂志, 2021, 8(4): 1-5.
14.	罗湘, 李涛, 朱继业, 等. 三维重建在精准肝切除治疗复杂原发性肝癌术前评估中的应用. 中华医学杂志, 2021, 101(28): 2210-2215.
15.	郑树国, 王保林. 腹腔镜肝切除术中出血的风险因素及对策. 中国实用外科杂志, 2022, 42(9): 970-974.
16.	Xu Y, Chen M, Meng X, et al. Laparoscopic anatomical liver resection guided by real-time indocyanine green fluorescence imaging: experience and lessons learned from the initial series in a single center. Surg Endosc, 2020, 34(10): 4683-4691.
17.	Chiow AKH, Rho SY, Wee IJY, et al. Robotic ICG guided anatomical liver resection in a multi-centre cohort: an evolution from “positive staining” into “negative staining” method. HPB (Oxford), 2021, 23(3): 475-482.
18.	肖乐, 李建伟, 陈健, 等. 腹腔镜与开腹肝切除术治疗肝脏后上段肿瘤的病例对照研究. 第三军医大学学报, 2014, 36(24): 2471-2475.
19.	林德新, 常贵建, 卓信斌, 等. 基于Laennec膜理论的规范化腹腔镜肝段切除术的研究进展. 中国普通外科杂志, 2024, 33(7): 1153-1161.
20.	李云峰, 尹新民. 腹腔镜解剖性肝Ⅶ段切除术的难点与应对策略. 中华消化外科杂志, 2021, 20(2): 178-183.
21.	Xiao L, Li JW, Zheng SG. Laparoscopic anatomical segmentectomy of liver segments Ⅶ and Ⅷ with the hepatic veins exposed from the head side (with videos). J Surg Oncol, 2016, 114(6): 752-756.
22.	Xiang L, Xiao L, Li J, et al. Safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma in the posterosuperior liver segments. World J Surg, 2015, 39(5): 1202-1209.
23.	陶常诚, 吴凡, 荣维淇, 等. 腹腔镜解剖性肝Ⅷ段切除16例临床效果分析. 中华肝胆外科杂志, 2023, 29(5): 328-332.
24.	魏勇, 牛洪凯, 马维杰, 等. 肝蒂优先路径腹腔镜解剖性肝Ⅷ段切除13例报道. 中华肝胆外科杂志, 2024, 30(4): 254-258.
25.	尤楠, 李靖, 吴柯, 等. 腹腔镜下以肝中静脉为引导的肝实质优先入路解剖性肝脏S8段切除的临床应用价值. 中国普外基础与临床杂志, 2021, 28(2): 146-150.
26.	Hou Z, Xie Q, Liao M, et al. Laparoscopic anatomical resection of paracaval portion of caudate lobe and segment 8 for HCC in an HCV-related cirrhotic patient. Ann Surg Oncol, 2023, 30(8): 4927-4928.
27.	Sun T, Wang X, Cao L, et al. Laparoscopic liver resection for primary liver cancers originating in the paracaval portion of the caudate lobe: a preliminary retrospective analysis with 31 patients. Updates Surg, 2022, 74(2): 547-555.
28.	Matsui Y, Terakawa N, Satoi S, et al. Postoperative outcomes in patients with hepatocellular carcinomas resected with exposure of the tumor surface: clinical role of the no-margin resection. Arch Surg, 2007, 142(7): 596-602,603.
29.	Sakamoto Y, Nara S, Hata S, et al. Prognosis of patients undergoing hepatectomy for solitary hepatocellular carcinoma originating in the caudate lobe. Surgery, 2011, 150(5): 959-967.
30.	Sun TG, Wang XJ, Cao L, et al. Laparoscopic anterior hepatic transection for resecting lesions originating in the paracaval portion of the caudate lobe (with videos). Surg Endosc, 2021, 35(9): 5352-5358.
31.	孙天歌, 王小军, 曹利, 等. 腹腔镜与开腹肝切除治疗肝尾状叶腔静脉旁部肿瘤的临床研究. 第三军医大学学报, 2021, 43(7): 640-647.

1. 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗指南(2024年版). 中华外科杂志, 2024, 62(6): 477-503.
2. Wang Q, Li HJ, Dai XM, et al. Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: Systematic review and meta-analysis of propensity-score matched studies. Int J Surg, 2022, 105: 106821. doi: 10.1016/j.ijsu.2022.106821.
3. Buell JF, Cherqui D, Geller DA, et al. The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg, 2009, 250(5): 825-830.
4. Wakabayashi G, Cherqui D, Geller DA, et al. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg, 2015, 261(4): 619-629.
5. 陈孝平, 张万广. 中国腹腔镜肝癌手术20年回顾与展望. 中华普外科手术学杂志(电子版), 2021, 15(4): 355-358.
6. 俞巍, 张洪义, 邢颖, 等. 肝脏恶性肿瘤术前肝功能评估和影像学评估. 中国临床医生杂志, 2022, 50(5): 512-516.
7. Liao K, Yang K, Cao L, et al. Laparoscopic anatomical versus non-anatomical hepatectomy in the treatment of hepatocellular carcinoma: a randomised controlled trial. Int J Surg, 2022, 102: 106652. doi: 10.1016/j.ijsu.2022.106652.
8. Moris D, Tsilimigras DI, Kostakis ID, et al. Anatomic versus non-anatomic resection for hepatocellular carcinoma: A systematic review and meta-analysis. Eur J Surg Oncol, 2018, 44(7): 927-938.
9. Feng X, Su Y, Zheng S, et al. A double blinded prospective randomized trial comparing the effect of anatomic versus non-anatomic resection on hepatocellular carcinoma recurrence. HPB (Oxford), 2017, 19(8): 667-674.
10. Berardi G, Igarashi K, Li CJ, et al. Parenchymal sparing anatomical liver resections with full laparoscopic approach: description of technique and short-term results. Ann Surg, 2021, 273(4): 785-791.
11. Zhu P, Liao W, Zhang WG, et al. A prospective study using propensity score matching to compare long-term survival outcomes after robotic-assisted, laparoscopic, or open liver resection for patients with BCLC stage 0-A hepatocellular carcinoma. Ann Surg, 2023, 277(1): e103-e111. doi: 10.1097/SLA.0000000000005380.
12. Tian F, Leng S, Chen J, et al. Long-term outcomes of laparoscopic liver resection versus open liver resection for hepatocellular carcinoma: A single-center 10-year experience. Front Oncol, 2023, 13: 1112380. doi: 10.3389/fonc.2023.1112380.
13. 郑博文, 郑树国. 腹腔镜解剖性肝切除术治疗肝细胞癌的现状与思考. 肝癌电子杂志, 2021, 8(4): 1-5.
14. 罗湘, 李涛, 朱继业, 等. 三维重建在精准肝切除治疗复杂原发性肝癌术前评估中的应用. 中华医学杂志, 2021, 101(28): 2210-2215.
15. 郑树国, 王保林. 腹腔镜肝切除术中出血的风险因素及对策. 中国实用外科杂志, 2022, 42(9): 970-974.
16. Xu Y, Chen M, Meng X, et al. Laparoscopic anatomical liver resection guided by real-time indocyanine green fluorescence imaging: experience and lessons learned from the initial series in a single center. Surg Endosc, 2020, 34(10): 4683-4691.
17. Chiow AKH, Rho SY, Wee IJY, et al. Robotic ICG guided anatomical liver resection in a multi-centre cohort: an evolution from “positive staining” into “negative staining” method. HPB (Oxford), 2021, 23(3): 475-482.
18. 肖乐, 李建伟, 陈健, 等. 腹腔镜与开腹肝切除术治疗肝脏后上段肿瘤的病例对照研究. 第三军医大学学报, 2014, 36(24): 2471-2475.
19. 林德新, 常贵建, 卓信斌, 等. 基于Laennec膜理论的规范化腹腔镜肝段切除术的研究进展. 中国普通外科杂志, 2024, 33(7): 1153-1161.
20. 李云峰, 尹新民. 腹腔镜解剖性肝Ⅶ段切除术的难点与应对策略. 中华消化外科杂志, 2021, 20(2): 178-183.
21. Xiao L, Li JW, Zheng SG. Laparoscopic anatomical segmentectomy of liver segments Ⅶ and Ⅷ with the hepatic veins exposed from the head side (with videos). J Surg Oncol, 2016, 114(6): 752-756.
22. Xiang L, Xiao L, Li J, et al. Safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma in the posterosuperior liver segments. World J Surg, 2015, 39(5): 1202-1209.
23. 陶常诚, 吴凡, 荣维淇, 等. 腹腔镜解剖性肝Ⅷ段切除16例临床效果分析. 中华肝胆外科杂志, 2023, 29(5): 328-332.
24. 魏勇, 牛洪凯, 马维杰, 等. 肝蒂优先路径腹腔镜解剖性肝Ⅷ段切除13例报道. 中华肝胆外科杂志, 2024, 30(4): 254-258.
25. 尤楠, 李靖, 吴柯, 等. 腹腔镜下以肝中静脉为引导的肝实质优先入路解剖性肝脏S8段切除的临床应用价值. 中国普外基础与临床杂志, 2021, 28(2): 146-150.
26. Hou Z, Xie Q, Liao M, et al. Laparoscopic anatomical resection of paracaval portion of caudate lobe and segment 8 for HCC in an HCV-related cirrhotic patient. Ann Surg Oncol, 2023, 30(8): 4927-4928.
27. Sun T, Wang X, Cao L, et al. Laparoscopic liver resection for primary liver cancers originating in the paracaval portion of the caudate lobe: a preliminary retrospective analysis with 31 patients. Updates Surg, 2022, 74(2): 547-555.
28. Matsui Y, Terakawa N, Satoi S, et al. Postoperative outcomes in patients with hepatocellular carcinomas resected with exposure of the tumor surface: clinical role of the no-margin resection. Arch Surg, 2007, 142(7): 596-602,603.
29. Sakamoto Y, Nara S, Hata S, et al. Prognosis of patients undergoing hepatectomy for solitary hepatocellular carcinoma originating in the caudate lobe. Surgery, 2011, 150(5): 959-967.
30. Sun TG, Wang XJ, Cao L, et al. Laparoscopic anterior hepatic transection for resecting lesions originating in the paracaval portion of the caudate lobe (with videos). Surg Endosc, 2021, 35(9): 5352-5358.
31. 孙天歌, 王小军, 曹利, 等. 腹腔镜与开腹肝切除治疗肝尾状叶腔静脉旁部肿瘤的临床研究. 第三军医大学学报, 2021, 43(7): 640-647.

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