Optimizing Surgical Outcomes in Oncology: Innovations and Challenges

Across cancer surgery, teams are increasingly weighing central hepatectomy for perihilar cholangiocarcinoma alongside evolving postoperative opioid stewardship, explicitly balancing a parenchyma‑sparing operative approach with active efforts to reduce prolonged opioid use.

Central hepatectomy—also referred to as mesohepatectomy—typically involves resection of segments IV, V, and VIII with biliary reconstruction when indicated, clarifying terminology at first mention.

Central hepatectomy is a parenchyma‑sparing surgical approach under consideration for perihilar cholangiocarcinoma. Central hepatectomy, a parenchyma‑sparing surgical approach (often resecting segments IV, V, and VIII with biliary reconstruction), is being considered for selected perihilar cholangiocarcinoma because it aims to preserve functional remnant while maintaining oncologic quality; reported comparative outcomes emphasize lower risks tied to inadequate future liver remnant (such as post‑hepatectomy liver failure) with margins and morbidity that can be comparable in experienced centers, as outlined in the comparative outcomes of central hepatectomy.

Because tissue preservation can help maintain hepatic reserve, the choice between central and major hepatectomy often intersects with patient frailty and comorbidity profiles. Beyond potential benefits, central hepatectomy carries procedure‑specific risks: vascular and biliary reconstructions are frequently required, and outcomes depend on experienced teams in high‑volume settings. In parallel, patient factors such as frailty shape perioperative vulnerability; a recent report on surgical frailty and gut imbalance offers context on why physiologic reserve matters for risk stratification.

These technical demands mean the operation is best considered in experienced, high‑volume centers for carefully selected patients, rather than a universal default.

Persistent opioid use after cancer surgery is a measurable concern: in cohorts undergoing early‑stage procedures, a notable minority continue or newly start opioids beyond typical recovery windows (for example, persistence assessed at around 90 days post‑op), underscoring the need for structured stewardship programs, as highlighted in reporting on postoperative opioid prescribing patterns.

Pain management protocols are increasingly emphasizing multimodal, opioid‑sparing care as recommended by perioperative guidelines, while recognizing that the evidence base spans heterogeneous procedures and settings. Separately, clinician‑facing behavior change methods are informing postoperative deprescribing pathways and safer tapering, synthesized in an analysis of behaviour change techniques in opioid deprescribing strategies.

Key Takeaways:

• Parenchyma‑sparing resection strategies can preserve physiologic reserve, which pairs with opioid‑sparing care to support earlier mobilization and safer recovery.
• Selection for central hepatectomy should align tumor anatomy with center expertise, while patient frailty guides perioperative intensity and risk mitigation.
• Structured postoperative opioid stewardship—grounded in clear timelines, taper plans, and follow‑up—reduces the likelihood of persistent use after early‑stage cancer surgery.
• Teamwide adherence to perioperative guidelines and deprescribing principles links operative planning to long‑term outcomes patients feel at home.