Yin Tao

    Department of Hepato-biliary-pancreatic Surgery, Hubei Cancer Hospital

    At present, hepatectomy is still the most effective method for the treatment of HCC. The large number of irregular hepatectomy is non-anatomical resection domestically. It is usually done under the guidance of finger. The extent of the tumor, especially deep tumor, is usually underestimated, and easily caused tumor margin residual which may be associated with high post-operative recurrence rate. Anatomical hepatectomy, which is strictly based on Couinaud segments, could remove tumor bearing liver segment and portal venous tumor emboli. This method has high local cure rate and good long-term effect and is recognized as the best treatment for HCC.

    Glissonean pedicle transection method for hepatectomy is an important technical method for anatomical hepatectomy, which is first reported by Professor Ken Takasaki from Tokyo Women Medical University. The technical features of the operation is directly transecting the Glisson sheath within the liver or near liver hilar region, in stead of dissecting the hepatic pedicle structure respectively, controlling blood supply of tumor segment to the greatest extent, and reducing the extrusion for tumor. The previous methods of opening Glisson sheath and then cutting off portal vein, hepatic artery and bile duct, respectively is abandoned. Large retrospective analysis by Takasaki showed, regardless of the size, the 5-year survival rate of HCC underwent Glissonean pedicle transection method for hepatectomy is as high as 75% and 10-year survival rate is 50%, which is the set of data with the best curative effect. The technology is simple and practical without rely on intraoperative ultrasound, consistent with the principles of surgical treatment of liver cancer mostly and surgical oncology disease-free technology, could reduce the dissemination via portal vein and significantly reduce intraoperative hemorrhage. Professor Bismuth, World-class master of Hepatobiliary surgery from France, evaluates that Glissonean pedicle transection method is the best way to local control blood flow and implement anatomical hepatectomy.

    The 21st century is the age of precise hepatectomy. Precise hepatectomy is designed to remove goal lesions thoroughly and to ensure anatomical intact and functional volume maximization of the residual liver at the same time, and control hemorrhage and systemic trauma entirely, eventually enable patients to get the best treatment efficacy. Anatomical hepatectomy based on segment  embodies accurately the concept of precise hepatectomy. The key is precise definition the interface of removal tumor bearing liver segment. Glissonean pedicle transection method for anatomical liver resection has been launched in hundreds of HCC cases and achieved good results in our department these years. Since adopting the technique, intraoperative blood loss was decreased significantly, thus could be with less or no blood transfusion. Recent recurrence rate is decreased, obtaining the increased chance of long-term survival. Adopting the method also helps to implement anatomical hepatectomy in situ for large HCC and cases traditional methods cannot remove. Our data suggest that Glissonean pedicle transection method for primary liver cancer can be resected completely and effectively, with simple operation procedure, no special equipment, prevent the recurrence and metastasis of HCC, and is worthy of popular application.