Editor’s Note: At the recent The 9th Congress of the Chinese Chapter of the International Hepato-Pancreato-Biliary Association (CCIHPBA), Prof. Chaoliu Dai from Shengjing Hospital of China Medical University presented on “Controlling Intraoperative Hemorrhage and Protecting Residual Liver Function in Hepatectomy.” Oncology frontier invited Prof. Dai to delve further into this topic and share insights from his presentation.

Oncology frontier: In your presentation, you discussed hemorrhage control and residual liver protection during hepatectomy. Could you summarize the core points for our readers?

Prof. Chaoliu Dai: The history of liver surgery can be seen as a history of surgeons tackling bleeding. Despite significant advancements, effective hemorrhage control, proper use of hemostatic techniques, and protection of residual liver function remain key concerns to minimize mortality associated with hepatectomy. My presentation focused on managing intraoperative bleeding, especially for large hepatic hemangiomas that are prone to bleed, and choosing the appropriate surgical approach and preserving residual liver function to prevent hemorrhage and maintain liver health post-surgery.

Oncology frontier: With laparoscopic hepatectomy becoming more prevalent, how do you evaluate the current methods for intraoperative bleeding control? What unmet needs still exist?

Prof. Chaoliu Dai: The development of laparoscopic hepatectomy has been rapid in recent years. In major medical centers, laparoscopic outcomes for liver resection by experienced surgeons can rival open surgery. However, laparoscopic procedures lack the tactile feedback of open surgery, making hemostasis challenging. Traditional open surgery techniques for bleeding control are applicable in laparoscopic settings but lack the hands-on precision. Progress in laparoscopic liver surgery relies on a strong team and a conducive learning environment. Additionally, technological advancements like ultrasonic scalpel resection, radiofrequency hemostasis, water jet dissection, and ultrasonic aspiration (CUSA) have improved hemostasis in liver parenchymal bleeding, allowing surgeons to better manage intraoperative bleeding.

Oncology frontier: In terms of residual liver function protection, what are the main areas of exploration in recent years?

Prof. Chaoliu Dai: Traditionally, liver surgery focused on “what to cut and how much to cut.” Nowadays, attention has shifted to “what to preserve and how much to preserve.” Preserving liver function throughout surgery reflects the importance of sparing liver parenchyma and ensuring optimal liver health post-resection. This involves preoperative liver function assessment, meticulous surgical technique, and careful postoperative management.

Oncology frontier: How do you view the clinical role of hepatoprotective agents like S-adenosylmethionine (SAMe) in protecting residual liver function?

Prof. Chaoliu Dai: As liver surgeons, our primary focus is on performing effective, minimally traumatic surgery. However, hepatoprotective drugs have developed rapidly, and SAMe, commonly used in clinical practice, is one such example. Other hepatoprotective agents that protect cell membranes and have anti-inflammatory effects can aid in repairing liver damage caused by surgery. While surgery is paramount in preserving liver function, these drugs provide valuable support, enhancing overall outcomes when used judiciously.

Prof. Chaoliu Dai

• Professor and Chief Surgeon, Hepato-Pancreato-Biliary Surgery, Shengjing Hospital, China Medical University
• Member, Liver Surgery Sub-Committee, Chinese Medical Association
• Vice Chairman, Liver Cancer Committee, Chinese Anti-Cancer Association
• Holds numerous key roles in medical and surgical societies across China
• Published extensively on liver surgery and liver cancer, with a focus on innovative surgical techniques