Surgeons need to reconsider the staging of multifocal intrahepatic cholangiocarcinoma as all cases should be classified as AJCC stage III, impacting surgical decision-making.

• Patients with multifocal tumors showed worse overall survival (26.1 vs. 60.0 months) and disease-free survival (9.8 vs. 25.0 months) compared to solitary tumors of stage II.
• Genomic profiling revealed that both satellite lesions and intrahepatic metastasis share a clonal origin, indicating they are manifestations of the same disease progression.

Recognizing the clonal nature and poor prognosis of multifocal lesions can guide patient selection for curative-intent surgery.

Surgeons can refine liver surgery strategies with a new patient-specific segmentation method focused on vascular structures.

• This new hepatic and portal vein-based classification (hpvc) showed better anatomical alignment than conventional methods, particularly for complex liver segments 5 and 8.
• Surgeons rated hpvc higher in accuracy for surgical planning and anatomical adherence compared to traditional classifications and an automated deep learning tool.

Integrating hpvc into clinical workflows could significantly enhance outcomes in complex liver surgeries.

• Significant volumetric discrepancies were found among the methods, highlighting the importance of choosing the right segmentation approach.

Frequent access to robotic platforms leads to better outcomes in liver resection.

• Conversion rate was 10.8%, with significant variance in blood loss based on imm grade: 184 ml (grade 1), 381 ml (grade 2), 753 ml (grade 3).
• Competency was achieved faster by surgeons with high-frequency access (35 cases vs. 47 cases).

Structured training and regular access are vital for minimizing complications in robotic liver surgery.

• Key risk factors for complications include age over 70, metabolic syndrome, tumor size >5 cm, and lower procedural frequency.

Anatomical resection can significantly reduce early recurrence rates in select hepatocellular carcinoma patients.

• In patients with tumors ≤5 cm and non-smooth margins, anatomical resection led to a 16.76% absolute reduction in early recurrence risk.
• Patients with these characteristics showed improved recurrence-free survival compared to non-anatomical resection.

Identifying patients with specific radiological features can optimize surgical decision-making and enhance outcomes in HCC treatment.

• Over 30% of patients who underwent non-anatomical resection might have benefited from anatomical resection.