Hepatocellular carcinoma (HCC) is the sixth cause of death worldwide. Surgery is considered the standard of care with negative resection margin (R0), the so-called R0 resection.
1 Laparoscopy has revolutionized surgery over the past few years, but minimally invasive liver resection remains one of the most demanding surgical procedure, because it requires considerable experience and a structured learning curve. The impact of resection margin on HCC survival and recurrence has been widely investigated in literature with contrasting results. R0 resection, in fact, is not always feasible, due to tumor position and contact with major vessels. In these cases, in order to achieve R0 resection, major liver resection with extended sacrifice of the liver parenchyma could expose patients with altered liver function due to subjacent liver cirrhosis, at the risk of consequent postoperative liver failure. Thus, the concept of R1 vascular hepatectomy (R1vasc) has been introduced and defined as the exposure of the tumor on the specimen surface due to its detachment from vascular structures.
2,3 The realization of R1 vascular resection is a demanding procedure, requiring advanced minimally invasive surgical skills: a thorough knowledge of preoperative MRI images, CT-scan and 3D-reconstruction, solid experience in intraoperative ultrasound, advanced surgical abilities in both open and laparoscopic surgery such as the capability to manage large vessels bleeding. …
