1.Primary liver cancer (hereinafter referred to as liver cancer) is one of the common malignant tumors in China. The recent survey of causes of death in our province shows that liver cancer is the first cause of death in our province. Hepatectomy is the preferred method of liver cancer treatment. At present, according to Couinaud’s modern liver anatomy concept and biological behavior characteristics of liver cancer, the use of modern medical devices and the implementation of precise and anatomical hepatectomy can maximize the eradication rate of liver cancer and minimize the postoperative liver function damage, which is the mainstream and “standard” of current surgical treatment of liver cancer. The history and status of the development of surgical treatment of liver cancer in China in the late 60s and 70s, the surgical treatment of liver cancer is “regular hepatectomy” characterized by sacrificing a large piece of liver tissue, and the high perioperative mortality rate is daunting! The surgical treatment model of liver cancer is “irregular hepatectomy”, which is characterized by the minimum loss of liver tissue. The basic principle of hepatic cancer resection is “left-ruled and right-ruled”. The surgical mortality rate is significantly reduced, even “0” deaths in a large number of cases, which benefits patients with post-hepatitis B cirrhosis and liver cancer. The main disadvantage of irregular hepatectomy is that the extent of resection is often insufficient, and this surgery is often done under the guidance of finger touch. In recent years, with the advancement of preoperative liver function testing methods and surgical instruments as well as in-depth understanding of liver anatomy and biological characteristics of hepatocellular carcinoma, anatomical hepatic resection based on liver segments has gained increasing attention from the hepatic surgery community at home and abroad. The anatomical hepatectomy with hepatic segmental approach for hepatocellular carcinoma has shown a 5-year survival rate of 76% and a 10-year survival rate of 54% in a large number of cases, which is about 20% higher than all the reports so far, showing the great development space for the surgical treatment of hepatocellular carcinoma. 3.What is anatomical hepatectomy: In strict accordance with the Couinaud anatomical segmentation method, the tumor-bearing liver segment (one or more liver segments) is first cut into the hepatic blood flow, and then subhepatic segment, single hepatic segment or combined hepatic segment is resected along the intersegmental plane. Anatomic hepatectomy is also called systematic hepatectomy. The precise anatomical hepatectomy avoids the risk of postoperative liver failure due to sacrificing too much of the remaining liver in traditional “regular hepatectomy”, and avoids the risk of increased positive margin rate and even residual lesions in irregular hepatectomy. 4. The advantages of anatomical hepatectomy are as follows: high radicality: liver cancer cells can lead to intrahepatic micrometastases through the portal vein system, so anatomical resection can remove the possible micro-metastases in the liver segment together and block the portal vein of the liver segment where the liver cancer is located, which can effectively reduce the possibility of hepatocellular carcinoma dissemination through the portal vein caused by squeezing the liver tissue during the operation. Reducing the rate of postoperative liver failure while ensuring negative margins: Using intraoperative ultrasound to accurately determine whether the tumor is included in the segment to be resected can ensure adequate margins and retain the most non-tumor tissues to reduce postoperative liver failure Less bleeding: Modern liver anatomy has confirmed that there are no large blood vessels and bile ducts in the interface of the liver segment, so that the liver is severed through a non-vascular interface can reduce intraoperative bleeding. Studies by foreign scholars have reported that intraoperative and postoperative blood transfusion for hepatocellular carcinoma can promote recurrence of hepatocellular carcinoma. Performing anatomical resection with the use of Cusa knife to precisely dissect the intrahepatic duct system and accurately ligate the thicker and larger vessels can significantly reduce intraoperative bleeding, which can reduce the cost and improve the surgical outcome for patients with hepatocellular carcinoma. Low complications: Since the large blood vessels and bile ducts will not be destroyed, postoperative ischemia or necrosis of the residual liver will be avoided and postoperative complications will be reduced. 5.The best surgical procedure for hepatocellular carcinoma treatment – hepatic tract transection method: In the implementation of hepatocellular carcinoma resection, the previous method of cutting the portal vein, hepatic artery and bile duct separately by cutting the Glisson sheath is abandoned, and the right, middle and left Glisson sheaths are dissected out in the liver to control the blood flow into the liver respectively, and the whole bundle is cut off from the portal triad of the tumor-bearing liver segment to implement anatomical hepatic resection. It is gradually becoming a standard method of hepatic resection internationally. 7. Schematic diagram and example of anatomical hepatectomy performed by me: Example of single hepatic segment resection (S3 segment hepatocellular carcinoma resection, author’s surgical picture data) Example 1 Patient CT 8, ligated liver tip 9, significant ischemia of the hilar segment Anatomical hepatectomy is an ideal procedure for the safe and effective treatment of hepatocellular carcinoma. Further research on the relationship between residual liver function measurement and resected liver volume and expansion of indications for anatomical hepatectomy will certainly improve the surgical treatment of liver cancer in China.