PDF(Pubmed)
Abstract：
UNASSIGNED: Liver surgery is an essential component of hepatocellular carcinoma (HCC) treatment. Advances in surgical techniques and perioperative care have improved outcomes and have helped to expand surgical indications. However, liver fibrosis and cirrhosis still remain major problems for liver surgery due to the relevant impact on liver regeneration of the future liver remnant (FLR) after surgery. Especially in patients with clinically significant portal hypertension due to liver cirrhosis, surgery is limited. Despite recent efforts in developing predictive models, estimating the postoperative hepatic function remains difficult.
UNASSIGNED: In this review, we focus on the role of surgery in the treatment of HCC in structurally altered livers. The importance of assessing FLR with techniques such as contrast-enhanced CT, e.g., with the help of artificial intelligence is highlighted. Moreover, strategies for increasing the FLR with approaches like portal vein embolization and liver vein deprivation prior to surgery are discussed. Patient selection, minimally invasive liver surgery including robotic techniques, and perioperative concepts like the Enhanced Recovery After Surgery (ERAS) guidelines are identified as crucial parts of avoiding posthepatectomy liver failure.
UNASSIGNED: The need for ongoing research to optimize patient selection criteria and perioperative care and to develop innovative biomarkers for outcome prediction is emphasized.
UNASSIGNED: In this review, we focus on the role of surgery in the treatment of HCC in structurally altered livers. The importance of assessing FLR with techniques such as contrast-enhanced CT, e.g., with the help of artificial intelligence is highlighted. Moreover, strategies for increasing the FLR with approaches like portal vein embolization and liver vein deprivation prior to surgery are discussed. Patient selection, minimally invasive liver surgery including robotic techniques, and perioperative concepts like the Enhanced Recovery After Surgery (ERAS) guidelines are identified as crucial parts of avoiding posthepatectomy liver failure.
UNASSIGNED: The need for ongoing research to optimize patient selection criteria and perioperative care and to develop innovative biomarkers for outcome prediction is emphasized.
摘要：
■肝脏手术是肝细胞癌（HCC）治疗的重要组成部分。手术技术和围手术期护理的进步改善了预后，并有助于扩大手术适应症。然而,肝纤维化和肝硬化仍然是肝脏手术的主要问题，由于对未来肝残存（FLR）的肝再生的相关影响。特别是在肝硬化导致临床上有意义的门静脉高压症的患者中，手术是有限的。尽管最近在开发预测模型方面做出了努力，估计术后肝功能仍然困难。
■在这篇评论中，我们关注的是手术在肝脏结构改变的HCC治疗中的作用.用对比增强CT等技术评估FLR的重要性，例如，借助人工智能凸显。此外，讨论了在手术前通过门静脉栓塞和肝静脉剥夺等方法增加FLR的策略。患者选择,微创肝脏手术，包括机器人技术，和围手术期概念，如增强术后恢复（ERAS）指南被认为是避免切除术后肝功能衰竭的关键部分。
■强调需要持续研究以优化患者选择标准和围手术期护理，并开发用于结果预测的创新生物标志物。
■在这篇评论中，我们关注的是手术在肝脏结构改变的HCC治疗中的作用.用对比增强CT等技术评估FLR的重要性，例如，借助人工智能凸显。此外，讨论了在手术前通过门静脉栓塞和肝静脉剥夺等方法增加FLR的策略。患者选择,微创肝脏手术，包括机器人技术，和围手术期概念，如增强术后恢复（ERAS）指南被认为是避免切除术后肝功能衰竭的关键部分。
■强调需要持续研究以优化患者选择标准和围手术期护理，并开发用于结果预测的创新生物标志物。
