Novel strategies for precision surgical treatment of liver cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WU Hong ^1,2

1. Liver Transplant Center, Transplant Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Laboratory of Hepatic Artificial Intelligence Translation, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

WU Hong, Email: wuhong@scu.edu.cn

Keywords：

liver cancer; precision hepatectomy; anatomical hepatectomy; fluorescence navigation; minimally invasive surgery

DOI：

10.7507/1007-9424.202602037

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

With advancements in the concepts and techniques of liver cancer treatment, surgical management of liver cancer is advancing toward greater precision and individualization. This article systematically reviews the development of precision surgery for liver cancer, with a focus on the modern concept of anatomical liver resection based on portal vein watershed anatomy and liver segmentation. It evaluates the application and value of key technologies such as fluorescence navigation, hepatic segment blood flow control, and robotic surgery, and discusses the “dual-conversion therapy” strategy for unresectable liver cancer. This work provides theoretical insights and practical guidance for the precision and innovation of surgical treatment in liver cancer.

Citation： WU Hong. Novel strategies for precision surgical treatment of liver cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(3): 293-298. doi: 10.7507/1007-9424.202602037 Copy

1.	Mak LY, Liu K, Chirapongsathorn S, et al. Liver diseases and hepatocellular carcinoma in the Asia-Pacific region: burden, trends, challenges and future directions. Nat Rev Gastroenterol Hepatol, 2024, 21(12): 834-851.
2.	Singal AG, Kanwal F, Llovet JM. Global trends in hepatocellular carcinoma epidemiology: implications for screening, prevention and therapy. Nat Rev Clin Oncol, 2023, 20(12): 864-884.
3.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
4.	Chan SL, Sun HC, Xu Y, et al. The Lancet Commission on addressing the global hepatocellular carcinoma burden: comprehensive strategies from prevention to treatment. Lancet, 2025, 406(10504): 731-778.
5.	Li M, He H, Zhao X, et al. Burden of liver cancer and underlying etiologies in China from 1990 to 2021: a systematic analysis from the Global Burden of Disease Study 2021. Chin Med J (Engl), 2026, 139(3): 415-423.
6.	Kaibori M, Yoshii K, Umeda Y, et al. Surgical outcomes of laparoscopic versus open hepatectomy for left hepatocellular carcinoma: propensity score analyses using retrospective Japanese and Korean individual patient data. Liver Cancer, 2022, 12(1): 32-43.
7.	Pringle JH. V. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg, 1908, 48(4): 541-549.
8.	Juza RM, Pauli EM. Clinical and surgical anatomy of the liver: a review for clinicians. Clin Anat, 2014, 27(5): 764-769.
9.	Makuuchi M, Hasegawa H, Yamazaki S. Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet, 1985, 161(4): 346-350.
10.	Tang ZY, Yu YQ, Zhou XD, et al. Surgery of small hepatocellular carcinoma. Analysis of 144 cases. Cancer, 1989, 64(2): 536-541.
11.	Reich H, McGlynn F, DeCaprio J, et al. Laparoscopic excision of benign liver lesions. Obstet Gynecol, 1991, 78(5 Pt 2): 956-958.
12.	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.
13.	董家鴻, 黃志強. 精準肝切除—21世紀肝臟外科新理念. 中華外科雜志, 2009, 47(21): 1601-1605.
14.	Makuuchi M. Surgical treatment for HCC–special reference to anatomical resection. Int J Surg, 2013, 11 Suppl 1: S47-S49.
15.	Takasaki K. Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation. J Hepatobiliary Pancreat Surg, 1998, 5(3): 286-291.
16.	Shin SW, Kim TS, Ahn KS, et al. Effect of anatomical liver resection for hepatocellular carcinoma: a systematic review and meta-analysis. Int J Surg, 2023, 109(9): 2784-2793.
17.	Takamoto T, Makuuchi M. Precision surgery for primary liver cancer. Cancer Biol Med, 2019, 16(3): 475-485.
18.	Ratti F, Serenari M, Corallino D, et al. Augmented reality improving intraoperative navigation in minimally invasive liver surgery: an interplay between 3D reconstruction and indocyanine green. Updates Surg, 2024, 76(7): 2701-2708.
19.	Dupré A, Come P, Buiron C, et al. Correction: ASO author reflections: minimally invasive surgery, three-dimensional (3D) reconstruction and indocyanine green fluorescence: the perfect combo to enter the era of intraoperative liver navigation. Ann Surg Oncol, 2024, 31(13): 9247. doi: 10.1245/s10434-024-16296-4.
20.	Couinaud C. Segmental and lobar left hepatectomies; studies on anatomical conditions. J Chir (Paris), 1952, 68(11): 697-715.
21.	Sugioka A, Kato Y, Tanahashi Y. Systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection based on Laennec’s capsule: proposal of a novel comprehensive surgical anatomy of the liver. J Hepatobiliary Pancreat Sci, 2017, 24(1): 17-23.
22.	Ciria R, Berardi G, Nishino H, et al. A snapshot of the 2020 conception of anatomic liver resections and their applicability on minimally invasive liver surgery. A preparatory survey for the Expert Consensus Meeting on Precision Anatomy for Minimally Invasive HBP Surgery. J Hepatobiliary Pancreat Sci, 2022, 29(1): 41-50.
23.	謝國偉, 吳泓. 吲哚菁綠熒光顯像技術打開“肝臟四扇門”在腹腔鏡精準肝切除中的應用. 腹部外科, 2020, 33(3): 184-189.
24.	Qiu J, Wu H, Bai Y, et al. Mesohepatectomy for centrally located liver tumours. Br J Surg, 2013, 100(12): 1620-1626.
25.	Wan H, Lan T, Duan T, et al. New classification-oriented laparoscopic anatomical hepatectomy strategy for hepatocellular carcinoma invading two or more (sub)segments in the left lobe. Chin Med J (Engl), 2022, 135(21): 2599-2601.
26.	Quan D, Wall WJ. The safety of continuous hepatic inflow occlusion during major liver resection. Liver Transpl Surg, 1996, 2(2): 99-104.
27.	Takata H, Hirakata A, Ueda J, et al. Prediction of portal vein thrombosis after hepatectomy for hepatocellular carcinoma. Langenbecks Arch Surg, 2021, 406(3): 781-789.
28.	Onda S, Furukawa K, Shirai Y, et al. New classification-oriented treatment strategy for portal vein thrombosis after hepatectomy. Ann Gastroenterol Surg, 2020, 4(6): 701-709.
29.	Ninh KV, Nguyen NQ, Trinh SH, et al. The application of selective hepatic inflow vascular occlusion with anterior approach in liver resection: effectiveness in managing major complications and long-term survival. Int J Hepatol, 2021, 2021: 6648663. doi: 10.1155/2021/6648663.
30.	Kim SM, Hwang S, Moon DB, et al. Patch venoplasty for resecting tumor invading the retrohepatic inferior vena cava using total and selective hepatic vascular exclusion. Ann Hepatobiliary Pancreat Surg, 2021, 25(4): 536-543.
31.	Si-Yuan F, Yee LW, Yuan Y, et al. Pringle manoeuvre versus selective hepatic vascular exclusion in partial hepatectomy for tumours adjacent to the hepatocaval junction: a randomized comparative study. Int J Surg, 2014, 12(8): 768-773.
32.	Monden K, Sadamori H, Hioki M, et al. Intrahepatic glissonean approach for laparoscopic bisegmentectomy 7 and 8 with root-side hepatic vein exposure. Ann Surg Oncol, 2022, 29(2): 970-971.
33.	Zheng K, Liao A, Yan L, et al. Laparoscopic anatomic bi-segmentectomy (S3 and S4b) using the Glisson’s pedicle-first and intrahepatic anatomic markers approach. Surg Endosc, 2022, 36(10): 7859-7860.
34.	Sarely Israelashvili M, Zippel DB, Koller M, et al. Use of transportal balloon catheter occlusion of the portal triad in prevention of bleeding during liver resection. J Surg Oncol, 2005, 89(1): 39-42.
35.	Landsman ML, Kwant G, Mook GA, et al. Light-absorbing properties, stability, and spectral stabilization of indocyanine green. J Appl Physiol, 1976, 40(4): 575-583.
36.	Wang X, Teh CSC, Ishizawa T, et al. Consensus guidelines for the use of fluorescence imaging in hepatobiliary surgery. Ann Surg, 2021, 274(1): 97-106.
37.	Chen H, Wang Y, Xie Z, et al. Application effect of ICG fluorescence real-time imaging technology in laparoscopic hepatectomy. Front Oncol, 2022, 12: 819960. doi: 10.3389/fonc.2022.819960.
38.	Itoh S, Tomiyama T, Morinaga A, et al. Clinical effects of the use of the indocyanine green fluorescence imaging technique in laparoscopic partial liver resection. Ann Gastroenterol Surg, 2022, 6(5): 688-694.
39.	Desmettre T, Devoisselle JM, Mordon S. Fluorescence properties and metabolic features of indocyanine green (ICG) as related to angiography. Surv Ophthalmol, 2000, 45(1): 15-27.
40.	Jiang JX, Keating JJ, Jesus EM, et al. Optimization of the enhanced permeability and retention effect for near-infrared imaging of solid tumors with indocyanine green. Am J Nucl Med Mol Imaging, 2015, 5(4): 390-400.
41.	Saxena V, Sadoqi M, Shao J. Degradation kinetics of indocyanine green in aqueous solution. J Pharm Sci, 2003, 92(10): 2090-2097.
42.	Li Y, Dai C, Hua Z, et al. A human serum albumin-indocyanine green complex offers improved tumor identification in fluorescence-guided surgery. Transl Cancer Res, 2024, 13(1): 437-452.
43.	Gao F, Xie Q, Ran X, et al. Use of indocyanine green-human serum albumin complexes in fluorescence image-guided laparoscopic anatomical liver resection: a case series study (with video). Surg Endosc, 2024, 38(11): 6938-6947.
44.	Xia F, Liu X, Yan J, et al. Clinical and economic outcomes of robotic-assisted, laparoscopic, and open liver resection in BCLC 0/A hepatocellular carcinoma: a nationwide cohort study. Int J Surg, 2026, 112(2): 4166-4178.
45.	Kim SH, Kim KH, Pinto-Marques H, et al. Feasibility of robotic liver resection compared with laparoscopic and open liver resection for hepatocellular carcinoma: a network meta-analysis. Int J Surg, 2026, 112(1): 27-41.
46.	Pilz da Cunha G, Hoogteijling TJ, Besselink MG, et al. Robotic versus laparoscopic liver resection: a systematic review and meta-analysis of comparative studies. Int J Surg, 2025, 111(8): 5549-5571.
47.	Huber T, Huettl F, Tripke V, et al. Experiences with three-dimensional printing in complex liver surgery. Ann Surg, 2021, 273(1): e26-e27.
48.	Perica ER, Sun Z. A systematic review of three-dimensional printing in liver disease. J Digit Imaging, 2018, 31(5): 692-701.
49.	Oldhafer KJ, Stavrou GA, Prause G, et al. How to operate a liver tumor you cannot see. Langenbecks Arch Surg, 2009, 394(3): 489-494.
50.	Kenngott HG, Wagner M, Gondan M, et al. Real-time image guidance in laparoscopic liver surgery: first clinical experience with a guidance system based on intraoperative CT imaging. Surg Endosc, 2014, 28(3): 933-940.
51.	Liao Y, Cai Q, Zhang X, et al. Sequential transcatheter arterial chemoembolization and portal vein embolization before hepatectomy for the management of patients with hepatocellular carcinoma: a systematic review and meta-analysis. Updates Surg, 2023, 75(7): 1741-1750.
52.	Lu YX, Zhao JP, Zhang WG. Is ALPPS still appropriate for large or locally advanced hepatocellular carcinoma in an era of targeted agents and immunotherapy? Updates Surg, 2024, 76(3): 899-910.

1. Mak LY, Liu K, Chirapongsathorn S, et al. Liver diseases and hepatocellular carcinoma in the Asia-Pacific region: burden, trends, challenges and future directions. Nat Rev Gastroenterol Hepatol, 2024, 21(12): 834-851.
2. Singal AG, Kanwal F, Llovet JM. Global trends in hepatocellular carcinoma epidemiology: implications for screening, prevention and therapy. Nat Rev Clin Oncol, 2023, 20(12): 864-884.
3. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
4. Chan SL, Sun HC, Xu Y, et al. The Lancet Commission on addressing the global hepatocellular carcinoma burden: comprehensive strategies from prevention to treatment. Lancet, 2025, 406(10504): 731-778.
5. Li M, He H, Zhao X, et al. Burden of liver cancer and underlying etiologies in China from 1990 to 2021: a systematic analysis from the Global Burden of Disease Study 2021. Chin Med J (Engl), 2026, 139(3): 415-423.
6. Kaibori M, Yoshii K, Umeda Y, et al. Surgical outcomes of laparoscopic versus open hepatectomy for left hepatocellular carcinoma: propensity score analyses using retrospective Japanese and Korean individual patient data. Liver Cancer, 2022, 12(1): 32-43.
7. Pringle JH. V. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg, 1908, 48(4): 541-549.
8. Juza RM, Pauli EM. Clinical and surgical anatomy of the liver: a review for clinicians. Clin Anat, 2014, 27(5): 764-769.
9. Makuuchi M, Hasegawa H, Yamazaki S. Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet, 1985, 161(4): 346-350.
10. Tang ZY, Yu YQ, Zhou XD, et al. Surgery of small hepatocellular carcinoma. Analysis of 144 cases. Cancer, 1989, 64(2): 536-541.
11. Reich H, McGlynn F, DeCaprio J, et al. Laparoscopic excision of benign liver lesions. Obstet Gynecol, 1991, 78(5 Pt 2): 956-958.
12. 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.
13. 董家鴻, 黃志強. 精準肝切除—21世紀肝臟外科新理念. 中華外科雜志, 2009, 47(21): 1601-1605.
14. Makuuchi M. Surgical treatment for HCC–special reference to anatomical resection. Int J Surg, 2013, 11 Suppl 1: S47-S49.
15. Takasaki K. Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation. J Hepatobiliary Pancreat Surg, 1998, 5(3): 286-291.
16. Shin SW, Kim TS, Ahn KS, et al. Effect of anatomical liver resection for hepatocellular carcinoma: a systematic review and meta-analysis. Int J Surg, 2023, 109(9): 2784-2793.
17. Takamoto T, Makuuchi M. Precision surgery for primary liver cancer. Cancer Biol Med, 2019, 16(3): 475-485.
18. Ratti F, Serenari M, Corallino D, et al. Augmented reality improving intraoperative navigation in minimally invasive liver surgery: an interplay between 3D reconstruction and indocyanine green. Updates Surg, 2024, 76(7): 2701-2708.
19. Dupré A, Come P, Buiron C, et al. Correction: ASO author reflections: minimally invasive surgery, three-dimensional (3D) reconstruction and indocyanine green fluorescence: the perfect combo to enter the era of intraoperative liver navigation. Ann Surg Oncol, 2024, 31(13): 9247. doi: 10.1245/s10434-024-16296-4.
20. Couinaud C. Segmental and lobar left hepatectomies; studies on anatomical conditions. J Chir (Paris), 1952, 68(11): 697-715.
21. Sugioka A, Kato Y, Tanahashi Y. Systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection based on Laennec’s capsule: proposal of a novel comprehensive surgical anatomy of the liver. J Hepatobiliary Pancreat Sci, 2017, 24(1): 17-23.
22. Ciria R, Berardi G, Nishino H, et al. A snapshot of the 2020 conception of anatomic liver resections and their applicability on minimally invasive liver surgery. A preparatory survey for the Expert Consensus Meeting on Precision Anatomy for Minimally Invasive HBP Surgery. J Hepatobiliary Pancreat Sci, 2022, 29(1): 41-50.
23. 謝國偉, 吳泓. 吲哚菁綠熒光顯像技術打開“肝臟四扇門”在腹腔鏡精準肝切除中的應用. 腹部外科, 2020, 33(3): 184-189.
24. Qiu J, Wu H, Bai Y, et al. Mesohepatectomy for centrally located liver tumours. Br J Surg, 2013, 100(12): 1620-1626.
25. Wan H, Lan T, Duan T, et al. New classification-oriented laparoscopic anatomical hepatectomy strategy for hepatocellular carcinoma invading two or more (sub)segments in the left lobe. Chin Med J (Engl), 2022, 135(21): 2599-2601.
26. Quan D, Wall WJ. The safety of continuous hepatic inflow occlusion during major liver resection. Liver Transpl Surg, 1996, 2(2): 99-104.
27. Takata H, Hirakata A, Ueda J, et al. Prediction of portal vein thrombosis after hepatectomy for hepatocellular carcinoma. Langenbecks Arch Surg, 2021, 406(3): 781-789.
28. Onda S, Furukawa K, Shirai Y, et al. New classification-oriented treatment strategy for portal vein thrombosis after hepatectomy. Ann Gastroenterol Surg, 2020, 4(6): 701-709.
29. Ninh KV, Nguyen NQ, Trinh SH, et al. The application of selective hepatic inflow vascular occlusion with anterior approach in liver resection: effectiveness in managing major complications and long-term survival. Int J Hepatol, 2021, 2021: 6648663. doi: 10.1155/2021/6648663.
30. Kim SM, Hwang S, Moon DB, et al. Patch venoplasty for resecting tumor invading the retrohepatic inferior vena cava using total and selective hepatic vascular exclusion. Ann Hepatobiliary Pancreat Surg, 2021, 25(4): 536-543.
31. Si-Yuan F, Yee LW, Yuan Y, et al. Pringle manoeuvre versus selective hepatic vascular exclusion in partial hepatectomy for tumours adjacent to the hepatocaval junction: a randomized comparative study. Int J Surg, 2014, 12(8): 768-773.
32. Monden K, Sadamori H, Hioki M, et al. Intrahepatic glissonean approach for laparoscopic bisegmentectomy 7 and 8 with root-side hepatic vein exposure. Ann Surg Oncol, 2022, 29(2): 970-971.
33. Zheng K, Liao A, Yan L, et al. Laparoscopic anatomic bi-segmentectomy (S3 and S4b) using the Glisson’s pedicle-first and intrahepatic anatomic markers approach. Surg Endosc, 2022, 36(10): 7859-7860.
34. Sarely Israelashvili M, Zippel DB, Koller M, et al. Use of transportal balloon catheter occlusion of the portal triad in prevention of bleeding during liver resection. J Surg Oncol, 2005, 89(1): 39-42.
35. Landsman ML, Kwant G, Mook GA, et al. Light-absorbing properties, stability, and spectral stabilization of indocyanine green. J Appl Physiol, 1976, 40(4): 575-583.
36. Wang X, Teh CSC, Ishizawa T, et al. Consensus guidelines for the use of fluorescence imaging in hepatobiliary surgery. Ann Surg, 2021, 274(1): 97-106.
37. Chen H, Wang Y, Xie Z, et al. Application effect of ICG fluorescence real-time imaging technology in laparoscopic hepatectomy. Front Oncol, 2022, 12: 819960. doi: 10.3389/fonc.2022.819960.
38. Itoh S, Tomiyama T, Morinaga A, et al. Clinical effects of the use of the indocyanine green fluorescence imaging technique in laparoscopic partial liver resection. Ann Gastroenterol Surg, 2022, 6(5): 688-694.
39. Desmettre T, Devoisselle JM, Mordon S. Fluorescence properties and metabolic features of indocyanine green (ICG) as related to angiography. Surv Ophthalmol, 2000, 45(1): 15-27.
40. Jiang JX, Keating JJ, Jesus EM, et al. Optimization of the enhanced permeability and retention effect for near-infrared imaging of solid tumors with indocyanine green. Am J Nucl Med Mol Imaging, 2015, 5(4): 390-400.
41. Saxena V, Sadoqi M, Shao J. Degradation kinetics of indocyanine green in aqueous solution. J Pharm Sci, 2003, 92(10): 2090-2097.
42. Li Y, Dai C, Hua Z, et al. A human serum albumin-indocyanine green complex offers improved tumor identification in fluorescence-guided surgery. Transl Cancer Res, 2024, 13(1): 437-452.
43. Gao F, Xie Q, Ran X, et al. Use of indocyanine green-human serum albumin complexes in fluorescence image-guided laparoscopic anatomical liver resection: a case series study (with video). Surg Endosc, 2024, 38(11): 6938-6947.
44. Xia F, Liu X, Yan J, et al. Clinical and economic outcomes of robotic-assisted, laparoscopic, and open liver resection in BCLC 0/A hepatocellular carcinoma: a nationwide cohort study. Int J Surg, 2026, 112(2): 4166-4178.
45. Kim SH, Kim KH, Pinto-Marques H, et al. Feasibility of robotic liver resection compared with laparoscopic and open liver resection for hepatocellular carcinoma: a network meta-analysis. Int J Surg, 2026, 112(1): 27-41.
46. Pilz da Cunha G, Hoogteijling TJ, Besselink MG, et al. Robotic versus laparoscopic liver resection: a systematic review and meta-analysis of comparative studies. Int J Surg, 2025, 111(8): 5549-5571.
47. Huber T, Huettl F, Tripke V, et al. Experiences with three-dimensional printing in complex liver surgery. Ann Surg, 2021, 273(1): e26-e27.
48. Perica ER, Sun Z. A systematic review of three-dimensional printing in liver disease. J Digit Imaging, 2018, 31(5): 692-701.
49. Oldhafer KJ, Stavrou GA, Prause G, et al. How to operate a liver tumor you cannot see. Langenbecks Arch Surg, 2009, 394(3): 489-494.
50. Kenngott HG, Wagner M, Gondan M, et al. Real-time image guidance in laparoscopic liver surgery: first clinical experience with a guidance system based on intraoperative CT imaging. Surg Endosc, 2014, 28(3): 933-940.
51. Liao Y, Cai Q, Zhang X, et al. Sequential transcatheter arterial chemoembolization and portal vein embolization before hepatectomy for the management of patients with hepatocellular carcinoma: a systematic review and meta-analysis. Updates Surg, 2023, 75(7): 1741-1750.
52. Lu YX, Zhao JP, Zhang WG. Is ALPPS still appropriate for large or locally advanced hepatocellular carcinoma in an era of targeted agents and immunotherapy? Updates Surg, 2024, 76(3): 899-910.

Next Article
Current research landscape of targeted therapy and immunotherapy for intermediate to advanced hepatocellular carcinoma

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Novel strategies for precision surgical treatment of liver cancer

Abstract Full text Figures/Tables Video References Cited by

Next Article

Format

Content