关键词: 肝切除, 肝胆恶性肿瘤, 肿瘤生物学行为, 手术切缘, 肝储备功能

Abstract: Reasonable decision points for hepatectomy        LI Bin，JIANG Xiao-qing. Biliary Tract Surgery Department I, Eastern Hepatobiliary Surgery Hospital，Naval Military Medical University，Shanghai 200438，China 
Corresponding author：JIANG Xiao-qing，E-mail:jxq1225@ sina.com 
Abstract    Removal of diseased liver tissue is an effective treatment for the hepatobiliary disease, and a rational hepatectomy scheme needs to balance the key therapeutic goals of complete resection of the lesion, ensuring surgical safety and optimal patient prognosis. The decision to perform hepatectomy for malignant tumours of the hepatobiliary is based on the appropriate extent of hepatic resection, tumour margins, and an accurate assessment of liver reserve function. Studies have shown that the effects of several factors, including tumour biological heterogeneity, the presence of vascular traffic branches or regional overlap in blood flow distribution between liver segments, and neovascularisation of the tumour microenvironment, may weaken the therapeutic effect of performing anatomical liver resection in hepatocellular carcinoma, and that wide resection margin is an independently significant factor in the prognostic benefit of hepatocellular carcinoma. Lymph node metastasis is an important consideration in deciding the appropriate margins for mass-forming intrahepatic cholangiocarcinoma. Except for tumour involvement of the right hepatic hilum, there is no survival advantage of expanding the scope of hepatectomy for gallbladder cancer at the pT2 stage and beyond. The therapeutic value of R1-vas incision margins for hepatocellular carcinoma and colorectal liver metastases and for perihilar cholangiocarcinoma invading the hepatic artery warrants more exploratory studies. Based on the concept of preserving a more functional liver parenchyma, restrictive hepatectomy in combination with hepatic vein trunk resection is clinically valuable for hepatocellular carcinoma growing in the secondary porta of liver with the invasion of the hepatic vein trunk, and perihepatic portal surgery for Bismuth-Corlette type III-IV perihilar cholangiocarcinoma.

Key words: hepatectomy, hepatobiliary malignancy, tumour biology, surgical margin, liver reserve function