Pushing the boundaries of liver resection for liver cancer

Surgical resection is a cornerstone of curative therapy for hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA), the two most common primary liver malignancies. In most patients with HCC, underlying cirrhosis is present, whereas in iCCA an identifiable risk factor is often absent. Regardless of tumour type, surgical planning must account for the future liver remnant to minimise the risk of post-hepatectomy liver failure, evaluating not only its volume but also its functional reserve. Furthermore, a deeper knowledge of surgical oncological principles combined with integrative strategies, including systemic and locoregional therapies, has enabled downstaging and conversion of initially unresectable liver malignancies, expanding surgical eligibility across a growing spectrum of hepatic tumoural conditions. Additionally, advances in the understanding of molecular biology and new treatment strategies, particularly in iCCA, have the potential to further extend the boundaries of resectability.