摘要
Liver resection stands as the gold-standard therapeutic approach for selected cases of hepatocellular carcinoma(HCC). The extent of resectable parenchyma hinges upon the underlying liver function and its regenerativepotential. Consequently, cirrhosis may impede access to potentially curative interventions for HCC arising withinthis context. Cirrhotic patients undergoing liver resection face heightened susceptibility to post-hepatectomy liverfailure (PHLF). The clinical profile of PHLF bears a resemblance to a well-documented syndrome within the livertransplant (LT) domain: Small-for-size syndrome (SFSS), a form of graft failure observed in the postoperativephase following LT with undersized or partial organs. Management of SFSS targets mitigating the overflowsyndrome, achievable through diverse portal diversion techniques. Portal vein flow diversion encompassesprocedures redirecting a variable proportion of portal vein flow towards systemic circulation. Consequently,derivative procedures aim to directly alleviate portal hypertension. Side-to-side portocaval shunts emerge as themost straightforward and efficacious means of decompressing the portal system. Furthermore, they afford flowcalibration to diminish the incidence and severity of steal syndrome and hepatic encephalopathy, withoutcompromising efficacy or hepatic function. Translating insights gleaned from LT complexities involving SFSS to liverresection, strategies involving portal flow diversion warrant consideration in efforts to forestall PHLF. This approachaims to extend the frontiers of liver surgery, broadening access to hepatectomy with curative intent, either as astandalone intervention or as part of a comprehensive treatment regimen where LT serves as a secondary option.
