• Guido Torzilli, Fabio Procopio, Luca Viganò, Guido Costa, Andrea Fontana, Matteo Cimino, Matteo Donadon, and Daniele Del Fabbro.
• Division of Hepatobiliary & General Surgery, Department of Surgery, Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy.
• Ann. Surg. 2019 Feb 1; 269 (2): 331-336.

ObjectiveThis prospective intention-to-treat validation study evaluated the liver tunnel (LT) technique for patients having ≥1 deep centrally located liver tumor, with or without middle hepatic vein (MHV) invasion.BackgroundConservative surgery has been proposed for patients with deep liver tumors having complex relationships. LT is one such novel technique.MethodsEligible patients were prospectively enrolled for LT. LT relies on tumor-vessel detachment, and the presence of communicating veins if MHV resection is necessary.ResultsTwenty consecutive patients met the inclusion criteria: 17 had colorectal liver metastases, 1 had hepatocellular carcinoma, 1 had mass-forming cholangiocarcinoma, and 1 had mixed hepatocellular carcinoma-mass-forming cholangiocarcinoma. Nineteen patients underwent LT. The MHV was resected in 6 patients, always sparing segments 4i and 5. Overall, 180 lesions were removed (median 7; range 1-37): 79 lesions were included in the LT specimen (median 3; range 1-13). There was no in-hospital 90-day mortality. Overall morbidity occurred in 10 (50%) patients: major in 2 (10%). All complications were managed conservatively. After a median 15-month follow-up (range 6-48), 2 instances of cut-edge local recurrences were observed.ConclusionsThis study shows that LT is technically feasible and safe. Further studies are needed for standardizing its use.

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