**5. Surgical arts of right trisectionectomy**

The aim of liver resection in hepatocellular carcinoma is to remove the cancer with minimal operative risk. The major causes of hospital mortality associated with hepatectomy are postoperative hepatic failure, bleeding, and postoperative septic complications. It is obvious that surgical arts (skills) are extremely important for an ideal outcome of hepatectomy. The surgical arts of right trisectionectomy applied in my group are as follows:

**1.** Continuous single interruption of porta hepatis has been conventionally applied to attenuate bleeding. Based on the majority of HCCs company cirrhoses, the cirrhotic liver cannot tolerate liver ischemia as well as the normal liver. Compared with multiple intermittent hepatic inflow occlusion, continuous single interruption of porta hepatis significantly attenuates bleeding during hepatic resection. The author summarized a cohort of 459 cases hepatectomy for primary liver cancer patients. Among them, 33 cases of right trisectionectomies were performed. Continuous single interruption of porta hepatis has been applied for all of hepatectomy. The interruption of porta hepatis lasted 15 to 40 min. The operative mortality was 3.0% (1/33). These data suggested that contin‐ uous single interruption of the porta hepatis can be regarded as an effective and safe method to limit bleeding even if in right trisectionectomies [9].


### **6. Adjuvant therapy and therapy after recurrence**

**Figure 6.** The taping veins for right trisectionectomy in one type of variant. This figure shows one type of variant, i.e., middle vein and left vein joined together into IVC, in which 1 and 2 are of LHV and 3 and 4 are of MHC. During the execution of right trisectionectomy on this variant, the taped veins must be RHV (5,6) and MHV (3,4), but not LHV

The aim of liver resection in hepatocellular carcinoma is to remove the cancer with minimal operative risk. The major causes of hospital mortality associated with hepatectomy are postoperative hepatic failure, bleeding, and postoperative septic complications. It is obvious that surgical arts (skills) are extremely important for an ideal outcome of hepatectomy. The

**1.** Continuous single interruption of porta hepatis has been conventionally applied to attenuate bleeding. Based on the majority of HCCs company cirrhoses, the cirrhotic liver cannot tolerate liver ischemia as well as the normal liver. Compared with multiple intermittent hepatic inflow occlusion, continuous single interruption of porta hepatis significantly attenuates bleeding during hepatic resection. The author summarized a cohort of 459 cases hepatectomy for primary liver cancer patients. Among them, 33 cases of right trisectionectomies were performed. Continuous single interruption of porta hepatis has been applied for all of hepatectomy. The interruption of porta hepatis lasted 15 to 40 min. The operative mortality was 3.0% (1/33). These data suggested that contin‐ uous single interruption of the porta hepatis can be regarded as an effective and safe

surgical arts of right trisectionectomy applied in my group are as follows:

method to limit bleeding even if in right trisectionectomies [9].

**5. Surgical arts of right trisectionectomy**

292 Recent Advances in Liver Diseases and Surgery

(1,2).

Surgical therapy is best combined with appropriate adjuvant therapies based on individual situations of the patient. In case of tumor recurrence, the first choice is resection of the resectable tumor. Nevertheless, either surgical therapy or nonsurgical therapy, transcatheter arterial 7. Case report

7.1. Case 1

chemoembolization (TACE), radiofrequency ablation (RFA), percutaneous ethanol injection (PEI), cryotherapy coagulation therapy, ultrasound (US)-guided percutaneous microwave, high intensive focused ultrasound (HIFU), iodine125 brachytherapy, immunotherapy, cyto‐ therapy, etc., can be considered according to individual situations of the patient to perform personalized therapy. intensive focused ultrasound (HIFU), iodine125 brachytherapy, immunotherapy, cytotherapy, etc., can be considered according to individual situations of the patient to perform personalized therapy.
