The journal «Practical oncology» / Т. 20, №3, 2019, Hepatocellular carcinoma

Surgical treatment of hepatocellular cancer



Introduction: the principles of liver surgery have been described in the educational literature for many years, covering
the field of treatment for patients suffering from liver damage and stab wounds. However, formal liver resections became
more common only after the discovery of general anesthesia as a method of surgical anesthesia and antibiotics. The
first successful liver resection was performed by Dr. Langenbuch (C.J.A. Langenbuch) in 1888, although the patient was
reoperated due to bleeding. These complications did not stop surgeons from studying the structure of the liver, trying to
find effective methods for removing tumors. In 1897, Dr. Cantlie described the liver, which contributed to a deeper study
and analysis of the liver, and led to effective control of blood loss during surgery. One of the revolutionary contributions
to liver resection was made by Dr. Pringle, who in 1908 described the technique of compressing the incoming portal vein
vessels to reduce bleeding. Over the past 60 years, technological advances have led to the rapid development of various
methods of liver resection.
Liver resection is a complex surgical procedure because of the risk of extensive bleeding during dissection of the liver
and the complex anatomy of the biliary tract and blood vessels of the liver.

The method of issuing glisson knives in an extended hepatectomy: Bismuth previously described the two main
methods for performing right-sided hepatectomy. One of them is the so-called controlled hepatectomy method, and
the other describes the isolation of the glisson leg of the right lobe of the liver after dissection. The guided hepatectomy
method was described by Lort–Jacob (Lortat–Jacob); however, Foster and Berman, in his book Solid Liver Tumors,
mentions that in 1949 Honjo (Japan) performed an anatomical right-sided hepatectomy, which included the separation
of the right hepatic artery, right portal vein and right hepatic duct in the area of the gate of the liver. Bismuth combined
these two methods into one hepatectomy procedure. In 1984, Takasaki et al. (Takasaki et al.) first reported anterior
access to an extensive tumor located in the right lobe of the liver. He indicated that the bringing vessels were bandaged
and divided. Liver dissection should be performed before mobilization of the right lobe of the liver in order to avoid
manipulations when removing the tumor. This procedure is a safe and effective method of treating an extensive tumor
in the right lobe of the liver compared to the traditional approach. Surgeons should be able to apply this technique
when conducting a right-sided hepatectomy.

Conclusion: over the past 2 years, postoperative mortality after liver resection has decreased from 5,4% to 3% (including
patients with cirrhosis), due to increased attention to patient safety. However, the place for positive dynamics in this area
still remains. Due to the complexity of liver operations, this approach should be carried out in specialized institutions that
not only conduct such operations on an ongoing basis, but also teach the principles of minimally invasive surgery. In our
era, when priority is given to reducing costs in the field of medicine, comparing the costs and results of various methods
of liver resection plays an important role in the treatment of such patients.