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 Shuguo

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

Corresponding?author：

ZHENG Shuguo, Email: shuguozh@163.com

Keywords：

laparoscopy; hepatectomy; hepatocellular carcinoma; difficult sites of liver

DOI：

10.7507/1007-9424.202410096

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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.

Citation： ZHENG Bowen, ZHENG Shuguo. 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, 2024, 31(12): 1419-1423. doi: 10.7507/1007-9424.202410096 Copy

1.	中華人民共和國國家衛生健康委員會醫政醫管局. 原發性肝癌診療指南(2024年版). 中華外科雜志, 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.	陳孝平, 張萬廣. 中國腹腔鏡肝癌手術20年回顧與展望. 中華普外科手術學雜志(電子版), 2021, 15(4): 355-358.
6.	俞巍, 張洪義, 邢穎, 等. 肝臟惡性腫瘤術前肝功能評估和影像學評估. 中國臨床醫生雜志, 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.	鄭博文, 鄭樹國. 腹腔鏡解剖性肝切除術治療肝細胞癌的現狀與思考. 肝癌電子雜志, 2021, 8(4): 1-5.
14.	羅湘, 李濤, 朱繼業, 等. 三維重建在精準肝切除治療復雜原發性肝癌術前評估中的應用. 中華醫學雜志, 2021, 101(28): 2210-2215.
15.	鄭樹國, 王保林. 腹腔鏡肝切除術中出血的風險因素及對策. 中國實用外科雜志, 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.	肖樂, 李建偉, 陳健, 等. 腹腔鏡與開腹肝切除術治療肝臟后上段腫瘤的病例對照研究. 第三軍醫大學學報, 2014, 36(24): 2471-2475.
19.	林德新, 常貴建, 卓信斌, 等. 基于Laennec膜理論的規范化腹腔鏡肝段切除術的研究進展. 中國普通外科雜志, 2024, 33(7): 1153-1161.
20.	李云峰, 尹新民. 腹腔鏡解剖性肝Ⅶ段切除術的難點與應對策略. 中華消化外科雜志, 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.	陶常誠, 吳凡, 榮維淇, 等. 腹腔鏡解剖性肝Ⅷ段切除16例臨床效果分析. 中華肝膽外科雜志, 2023, 29(5): 328-332.
24.	魏勇, 牛洪凱, 馬維杰, 等. 肝蒂優先路徑腹腔鏡解剖性肝Ⅷ段切除13例報道. 中華肝膽外科雜志, 2024, 30(4): 254-258.
25.	尤楠, 李靖, 吳柯, 等. 腹腔鏡下以肝中靜脈為引導的肝實質優先入路解剖性肝臟S8段切除的臨床應用價值. 中國普外基礎與臨床雜志, 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.	孫天歌, 王小軍, 曹利, 等. 腹腔鏡與開腹肝切除治療肝尾狀葉腔靜脈旁部腫瘤的臨床研究. 第三軍醫大學學報, 2021, 43(7): 640-647.

1. 中華人民共和國國家衛生健康委員會醫政醫管局. 原發性肝癌診療指南(2024年版). 中華外科雜志, 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. 陳孝平, 張萬廣. 中國腹腔鏡肝癌手術20年回顧與展望. 中華普外科手術學雜志(電子版), 2021, 15(4): 355-358.
6. 俞巍, 張洪義, 邢穎, 等. 肝臟惡性腫瘤術前肝功能評估和影像學評估. 中國臨床醫生雜志, 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. 鄭博文, 鄭樹國. 腹腔鏡解剖性肝切除術治療肝細胞癌的現狀與思考. 肝癌電子雜志, 2021, 8(4): 1-5.
14. 羅湘, 李濤, 朱繼業, 等. 三維重建在精準肝切除治療復雜原發性肝癌術前評估中的應用. 中華醫學雜志, 2021, 101(28): 2210-2215.
15. 鄭樹國, 王保林. 腹腔鏡肝切除術中出血的風險因素及對策. 中國實用外科雜志, 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. 肖樂, 李建偉, 陳健, 等. 腹腔鏡與開腹肝切除術治療肝臟后上段腫瘤的病例對照研究. 第三軍醫大學學報, 2014, 36(24): 2471-2475.
19. 林德新, 常貴建, 卓信斌, 等. 基于Laennec膜理論的規范化腹腔鏡肝段切除術的研究進展. 中國普通外科雜志, 2024, 33(7): 1153-1161.
20. 李云峰, 尹新民. 腹腔鏡解剖性肝Ⅶ段切除術的難點與應對策略. 中華消化外科雜志, 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. 陶常誠, 吳凡, 榮維淇, 等. 腹腔鏡解剖性肝Ⅷ段切除16例臨床效果分析. 中華肝膽外科雜志, 2023, 29(5): 328-332.
24. 魏勇, 牛洪凱, 馬維杰, 等. 肝蒂優先路徑腹腔鏡解剖性肝Ⅷ段切除13例報道. 中華肝膽外科雜志, 2024, 30(4): 254-258.
25. 尤楠, 李靖, 吳柯, 等. 腹腔鏡下以肝中靜脈為引導的肝實質優先入路解剖性肝臟S8段切除的臨床應用價值. 中國普外基礎與臨床雜志, 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. 孫天歌, 王小軍, 曹利, 等. 腹腔鏡與開腹肝切除治療肝尾狀葉腔靜脈旁部腫瘤的臨床研究. 第三軍醫大學學報, 2021, 43(7): 640-647.

Previous Article
Comprehensive treatment strategy for hepatocellular carcinoma centered on surgical intervention
Next Article
Research progress of conversion therapy in hepatocellular carcinoma

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The difficulties and countermeasures of laparoscopic hepatectomy in the treatment of hepatocellular carcinoma in the difficult sites of liver

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content