Updates and Critical Insights on Glissonian Approach in Liver Surgery

Abstract

Recent advances in surgical techniques have broadened the indications of surgical management of liver malignancies. Intraoperative bleeding is one of the known predictors of postoperative outcomes following liver surgery, signifying the importance of vascular control during liver resection. Furthermore, preservation of future liver remnant plays a critical role in prevention of post-hepatectomy liver failure as one of the main causes of postoperative morbidity and mortality. Glissonian approach liver resection offers an effective method for vascular inflow control while protecting future liver remnant from ischemia-reperfusion injury. Several studies have demonstrated the feasibility of Glisson's pedicle resection technique in modern liver surgery with an acceptable safety profile. Moreover, with increasing popularity of minimally invasive surgery, laparoscopic liver resection via Glissonian approach has been shown to be superior to standard laparoscopic hepatectomy. Herein, we systematically review the role of Glissonian approach hepatectomy in current practice of liver surgery, highlighting its advantages and disadvantaged over other methods of vascular control.

Effect of Surgical Margin Width on Patterns of Recurrence among Patients Undergoing R0 Hepatectomy for T1 Hepatocellular Carcinoma: An International Multi-Institutional Analysis

“…Indeed, for an anatomic resection of liver, Glisson pipelines are ligated and cut off in advance. 20 In turn, more microvascular invasive lesionsthought to be strongly correlated with disease relapse-can theoretically be removed regardless of surgical margins when liver parenchyma is dissected. 20,21 In contrast, a previous report noted that, in the case of non-anatomic resections, a wider surgical margin should be considered approapriate.…”

Prognostic utility of albumin‐bilirubin grade for short‐ and long‐term outcomes following hepatic resection for intrahepatic cholangiocarcinoma: A multi‐institutional analysis of 706 patients

“…Most commonly, tumor‐associated factors such as tumor number, size, major vascular invasion as well as serum biomarkers, such as the carcinoembryonic antigen (CEA) and the cancer antigen (CA) 19‐9 have been correlated with clinical outcomes . Apart from tumor factors, assessment of the underlying liver function is crucial in determining the outcomes of patients undergoing liver surgery for ICC . Of note, the albumin‐bilirubin (ALBI) grading system has been proposed to provide a simple and objective method to evaluate the liver function reserve and, in turn, predict patient outcomes following liver surgery .…”

“…6,7 Apart from tumor factors, assessment of the underlying liver function is crucial in determining the outcomes of patients undergoing liver surgery for ICC. [9][10][11][12] Of note, the albumin-bilirubin (ALBI) grading system has been proposed to provide a simple and objective method to evaluate the liver function reserve and, in turn, predict patient outcomes following liver surgery. 13 Since its introduction in 2015, there has been a growing interest of the prognostic utility of ALBI grade, mainly focusing on patients undergoing surgery for hepatocellular carcinoma (HCC).…”

The Importance of the Glissonean Approach and Laennec Capsule Concept in Open Anatomical Liver Resections: What we Need to Know

“…While generally associated with low perioperative morbidity and mortality (less than 1%), the use of the Glissonean approach can be technically challenging in some cases (59,60). When performing the suprahilar control of Glissonean pedicle, gentle handling of anatomic structures is extremely important (61). Difficulty in encircling the pedicles or parenchymal bleeding during liver dissection at the suprahilar area are the most common causes of technical failure (60).…”

“…Difficulty in encircling the pedicles or parenchymal bleeding during liver dissection at the suprahilar area are the most common causes of technical failure (60). Also, the Glissonean approach may not be the best approach for tumors closely adjacent to the hilum, since transection of Glisson's pedicles can result in intraoperative tumor spread and recurrence (61).…”