4.3.1 Surgical Treatment of Liver Cancer

4.3.1 Surgical Treatment of Liver Cancer

As early as 1888, Langenbuch performed the first left hepatic lobectomy, a procedure that has since been practiced for over a century. With clearer anatomical understanding, improved diagnostic methods, and continuous refinement of surgical techniques, surgical resection of liver cancer has become the preferred treatment method, with higher 5-year survival rates for smaller tumors. Cai Jianqiang [86] performed various hepatic resections on 712 patients with primary liver cancer, with postoperative 1st-, 3rd-, and 5th-year survival rates of 88.3%, 49.3%, and 32.9%, respectively. Therefore, liver cancer resection can be divided into irregular and regular procedures. Regular resection is more thorough, removing not only the cancerous liver segment but also a larger portion of the surrounding non-cancerous liver tissue, which can affect the compensatory function of the remaining liver. Nowadays, irregular resection is more commonly performed, where only the tumor and a certain margin around it are removed, without affecting the blood supply to the remaining liver. However, in China, most patients are diagnosed at intermediate or advanced stages, significantly reducing the resection rate; only about 20% of patients receive resection. Clinical statistics combined with other comprehensive treatment methods show that postoperative complications and metastasis/recurrence have also improved considerably.

Liver transplantation technology in China has steadily improved, playing a crucial role in the surgical treatment of liver cancer. Liver transplantation is a radical cure for primary liver cancer, with 3-year survival and disease-free survival rates reaching 80% and 88%, respectively [87]. Not only does it completely remove the tumor, but it also eliminates the risk of intrahepatic and distant metastasis, avoiding liver failure after resection and achieving a complete cure. However, there are challenges, such as the source of the liver, post-transplant rejection, high recurrence rates after surgery, increased risk of infection, and the need for long-term immunosuppressive medication, meaning it cannot be applied to everyone.