Maximizing Parenchymal Preservation in Anatomical Hepatectomy: A Pathway to Precision Surgery for Hepatocellular Carcinoma

Abstract

Liver cancer has one of the highest incidence and mortality rates globally, and hepatectomy is the primary treatment for early to intermediate stages of the disease. As the treatment of liver cancer has evolved, traditional anatomical hepatectomy has not fully met clinical needs, leading to the gradual adoption of Parenchymal-sparing anatomical hepatectomy (limited anatomical hepatectomy) in clinical practice. This technique is tumor-centered and relies on the portal vein territory as a reference for anatomical tumor resection, aiming to maximize the preservation of functional hepatic parenchyma. This article reviews the theoretical foundations and clinical applications of anatomical hepatectomy with preservation of hepatic parenchyma. Its theoretical advantages include the potential to improve oncological control based on anatomical rationale, although robust clinical evidence remains limited, as well as enhancing the operability of recurrent liver cancer, broaden the indications for hepatectomy, decrease the incidence of postoperative liver failure, minimize patient trauma, and promote postoperative recovery. However, it is important to note that this approach is more complex than conventional anatomical hepatectomy, requiring higher standards of medical infrastructure and surgical expertise. Its precise impact on oncological outcomes and surgery-related complications still requires further investigation for validation.