Real-world adherence to BCLC treatment guidelines in hepatocellular carcinoma significantly impacts patient survival.

• Overall adherence was only 47.8%, with the best rates (93.5%) in stage D and the lowest (23.1%) in stage C.
• Patients following BCLC recommendations lived longer: 722 days versus 535 days for non-adherents.

Improving adherence, especially in early and advanced stages, is crucial for enhancing patient outcomes.

• Key predictors of adherence included Child-Pugh scores B/C and ECOG > 0.

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.