Special Interview with Prof. Lianxin Liu: Vice President of the University of Science and Technology of China

On February 6, 2025, Heptoma Research had the privilege of interviewing Prof. Lianxin Liu, Vice President of the University of Science and Technology of China and a distinguished Yangtze River Scholar awarded by the Ministry of Education of China. Prof. Liu, also an Associate Chief Editor of Hepatoma Research, shared invaluable insights on the evolving landscape of medical advancements.

As a pivotal contributor to the "2024 Edition of the Technical Guidelines for Minimally Invasive Surgery in Living Liver Donors in China," Prof. Liu has been at the forefront of integrating precision medicine with surgical innovation. His remarkable contributions to hepatocellular carcinoma (HCC) diagnosis, treatment, and the development of multidisciplinary team (MDT) systems have had a profound impact on modern medical practice. This exclusive interview highlights Prof. Liu’s visionary work and the practical application of advanced medical techniques.

Q1. You were involved in the development of the "2024 Edition of the Technical Guidelines for Minimally Invasive Surgery in Living Liver Donors in China," which introduces several innovative minimally invasive surgical methods. In your opinion, what key role do these innovations play in improving postoperative recovery and reducing complications for liver transplant donors? Among the minimally invasive surgical techniques for living liver donors in China, which technological innovations do you think are the most critical?

Prof. Lianxin Liu: Living liver donation is an essential solution to the liver donor shortage, especially in China, and it enables more patients to avoid the long waiting times for liver transplants.

With advancements in minimally invasive technologies, particularly laparoscopic and robotic techniques, minimally invasive liver harvesting has become a reality. These technologies significantly reduce the physical and psychological trauma to the donor. The core of these innovations, in my view, is ensuring the safety of the donor while achieving the same results with smaller incisions. Using laparoscopic and robotic methods, we can fully mobilize the liver and harvest it through minimal incisions, which allows us to transplant the liver into the recipient with minimal impact on the donor's body and mind.

Additionally, I discussed the "2024 Edition of the Technical Guidelines for Minimally Invasive Surgery in Living Liver Donors," which introduces several innovations. These guidelines focus on standardizing surgical procedures and steps, creating a framework for the widespread adoption of minimally invasive liver donation techniques. I believe that this technique should be implemented at large medical centers with experienced teams in liver transplantation and minimally invasive surgery to ensure its success and broader application.

Q2. In recent years, the application of precision medicine in cancer treatment has become increasingly widespread. For hepatocellular carcinoma (HCC), how can innovations in liver surgery be combined with precision medicine to achieve more effective personalized treatment? What key roles can precision medicine play in the early diagnosis, treatment plan selection, and prognosis assessment of hepatocellular carcinoma?

Prof. Lianxin Liu: The application of precision medicine in cancer treatment has become increasingly widespread, and for hepatocellular carcinoma (HCC), it holds immense potential. Precision medicine can play a critical role in the early diagnosis, treatment plan selection, and prognosis assessment of hepatocellular carcinoma.

Precision medicine, as a concept, has been evolving for a long time. Internationally, it was first proposed by President Obama, and in China, it was introduced by Academician Dong Jiahong, who proposed the concept of precision liver resection. The idea behind "precision" is not that our past methods were imprecise, but rather that, building upon the experience of our predecessors, advancements in modern technology now allow us to achieve more accurate outcomes.

In liver surgery, precision medicine involves several aspects. For early diagnosis, we now not only have serological methods but also advanced imaging techniques. For example, using specific contrast agents, we can detect tumors as small as 5mm. Our center, equipped with a 5.0T MRI, can detect tumors as small as 3mm, making early diagnosis more precise.

In surgical treatment, precision medicine enables us to perform accurate assessments, including three-dimensional reconstruction and virtual navigation technologies. These tools allow for more precise liver resections compared to previous methods. Pre-surgery, we can thoroughly analyze the liver's anatomy, making us aware of what lies beneath the surface, which helps guide the surgery. Virtual reality technology also supports us during surgery, ensuring better planning and execution.

In addition, post-surgery management is crucial. Precision medicine encourages more refined care, including preventing complications such as small liver syndrome and managing postoperative outcomes. Furthermore, in the context of advanced, unresectable liver cancer, precision medicine extends to the field of conversion therapy, where tailored treatments aim to make these cancers resectable.

Although we have not yet identified the same specific genetic mutations in liver cancer as seen in lung, colon, or breast cancers, there are still multi-target inhibitors and immunotherapy options that bring new prospects, particularly for patients with unresectable or borderline resectable liver cancers.

Q 3. What is your view on the prospects of artificial intelligence and digital technologies in the field of hepatobiliary surgery? What potential breakthroughs do you see in the combination of these technologies with surgery, such as the recently emerging DeepSeek?

Prof. Lianxin Liu: In recent years, artificial intelligence (AI) and digital technologies have become increasingly influential in the field of hepatobiliary surgery, and I believe their role in the future of medicine will be crucial. AI, in particular, has the potential to revolutionize the way we approach medical diagnoses and treatments. Unlike humans, AI does not need food or rest, so as long as it has energy, it can continue to work without interruption. This gives it a much higher tolerance for error, and its ability to learn from vast amounts of data makes it a valuable tool in clinical practice.

AI has the capacity to analyze data much more efficiently than humans, and I believe that some medical specialties will be more susceptible to transformation by AI than others. For example, imaging is one area where AI will play a significant role. AI-powered systems can detect abnormalities that may be missed by the human eye or overlooked due to fatigue. In fact, AI-assisted diagnostic tools, like those for detecting medical conditions in radiology, have already received approval in various countries, and we are using them in our own hospital.

Another field where AI could make a big impact is pathology. While pathologists still play a critical role in diagnosing complex cases, AI could automate the analysis of routine pathology samples, thus improving efficiency. In dermatology, AI is already being used to analyze skin conditions from images, which could reduce the burden on dermatologists for routine tasks.

In the case of hepatobiliary surgery, AI's role will be even more transformative. Surgeons can use AI to assist with preoperative planning, helping to create more accurate surgical roadmaps and predict potential complications. AI can also be used for postoperative care, enabling more precise monitoring and management of recovery, improving long-term outcomes for patients.

As for DeepSeek, which is one of the emerging technologies, we are beginning to experiment with it in our practice. Although it's not yet specifically tailored for medical applications, DeepSeek and similar technologies are part of the broader movement toward integrating AI into healthcare. In the future, I expect that specialized AI models will be developed for different areas of medicine, and they will become increasingly adept at learning from large datasets. These models will be able to provide clinicians with faster insights and better treatment recommendations based on the latest research and clinical data.

The combination of AI and digital technologies will undoubtedly reshape the landscape of healthcare, especially in fields like hepatobiliary surgery. As AI continues to evolve, I believe it will not only assist surgeons in their work but also improve the overall efficiency of medical systems. Ultimately, AI's ability to learn, adapt, and process vast amounts of information will lead to more personalized, effective, and precise treatments for patients, transforming the future of medicine in ways we can't yet fully imagine.

Q 4. At the 10th Annual Medical Conference in January, you shared your experience on MDT, quality control systems, and database construction in liver cancer treatment. What were the main challenges you encountered while promoting the institutionalization of MDT? During the provincial rollout, which key measures were most effective in improving the standardization of diagnosis and treatment?

Prof. Lianxin Liu: In my presentation at the 10th Annual Medical Conference in January, I shared my experiences with the MDT (multidisciplinary team) model, quality control systems, and database construction in the treatment of liver cancer. The MDT approach has been proven to be the most effective treatment method, as both history and practice have shown.

One of the main challenges we encountered while promoting the institutionalization of MDT was overcoming the limitations in each specialist's understanding. No single doctor, no matter how experienced, can master every aspect of a complex disease like liver cancer. For example, I specialize in surgery, but my knowledge in interventional radiology, oncology, or radiation therapy is certainly not as deep as that of specialists in those fields. Even the leading experts in any given area can’t be fully updated with every recent advancement unless they are constantly learning and staying immersed in their field.

The main obstacle we faced during the provincial rollout was convincing medical professionals to break away from the mindset of individual expertise. Many doctors are accustomed to thinking, "I know my field best, and I should make the decisions for treatment." But this approach might overlook newer, better treatments that could be more effective. MDT, however, encourages us to combine knowledge from various specialists to select the best possible treatment for the patient. It brings together the wisdom of multiple experts, ensuring that we don't miss out on valuable insights and the latest treatment advancements.

Through our efforts to promote MDT in the province, we highlighted the benefits of this approach, not only for patients but also for doctors and the healthcare system as a whole. MDT helps ensure the most efficient use of healthcare resources by ensuring that limited resources are directed toward the most effective treatments. This, in turn, has the potential to save valuable healthcare costs and improve patient outcomes.

Ultimately, I believe that the broader adoption of MDT will elevate the overall level of liver cancer treatment across the region. It will also enhance doctors' understanding of other specialties, fostering cross-discipline knowledge and improving the overall standard of care. In the end, the goal is to benefit patients and improve our healthcare system, ensuring the best outcomes with the resources we have.

Q5. Regarding the treatment of liver cancer, you participated in the preparation of the "Expert Consensus on Immunotherapy, Targeted Therapy, and Sequential Surgical Treatment for Advanced Hepatocellular Carcinoma (2024 Edition)." The guideline mentions the use of immune checkpoint inhibitors in combination with anti-angiogenesis targeted drugs in the treatment of advanced hepatocellular carcinoma. What specific improvements in overall efficacy do you think this combination therapy brings to liver cancer patients?

Prof. Lianxin Liu: In the preparation of the "Expert Consensus on Immunotherapy, Targeted Therapy, and Sequential Surgical Treatment for Advanced Hepatocellular Carcinoma (2024 Edition)," I contributed to outlining the use of immune checkpoint inhibitors in combination with anti-angiogenesis targeted drugs for the treatment of advanced hepatocellular carcinoma (HCC). This combination therapy brings significant improvements in overall efficacy for liver cancer patients, particularly in the context of advanced stages.

Historically, advanced liver cancer was considered incurable, but the introduction of Sorafenib in 2008 changed this landscape, offering new hope for treatment. Following this, the emergence of immunotherapies, particularly immune checkpoint inhibitors such as PD-1 and PD-L1 blockers, opened up even greater possibilities for cancer treatment. The combination of immune checkpoint inhibitors with other therapies, such as small molecule inhibitors and anti-angiogenesis agents, has added new dimensions to liver cancer treatment.

The key benefit of combining large molecule anti-angiogenesis inhibitors with PD-1 therapy in advanced, unresectable liver cancer is that it allows for effective suppression of angiogenesis without the severe side effects commonly associated with small molecule TKI (tyrosine kinase inhibitors). This combination targets both tumor growth and vascular support, providing better overall efficacy and improved outcomes.

However, this combination therapy does come with some risks, including potential complications like severe esophageal varices, which must be carefully monitored. New data from ASCO 2024 and other studies suggest that combination therapies, such as dual immunotherapy with PD-1 and PD-L1 inhibitors, might offer even greater benefits for advanced liver cancer patients. These treatments present a promising future, although immune-related adverse effects remain manageable.

Ultimately, the growing number of therapeutic options allows for a more personalized treatment approach. Patients now have the opportunity to choose from several effective therapies, based on their individual health conditions, treatment preferences, and insurance coverage. As more options become available, we can tailor treatments to maximize benefits and provide better outcomes for liver cancer patients.

Interviewee

Profile

Prof. Liu is a leading expert in liver and oncological surgery with vast experience in complex liver procedures. Notably, he was the first in the world to implement continuous intra-arterial infusion of arsenic trioxide to treat inoperable primary liver cancer—an approach that had a significant clinical impact. Prof. Liu is highly skilled in abdominal interventional surgery, minimally invasive procedures, and ultrasound-guided liver biopsies. He has also pioneered treatments for peritoneal mucinous tumors and complex general surgery cases.

Academic and Professional Appointments:

• Member, Surgery Branch of the Chinese Medical Association
• Deputy Leader, Experimental Surgery Group
• Vice President, Surgery Branch of the Chinese Medical Doctor Association
• Deputy Chair, Hepatic Surgery Committee
• Deputy Chair, Various Committees under the Chinese Research Hospital Association: General Surgery, Hepatobiliary Surgery, Enhanced Recovery After Surgery, and Clinical Digital Medicine
• Standing Member, Digestive Tract Tumor Committee
• Deputy Chair, Liver Cancer Committee, Chinese Anti-Cancer Association
• Deputy Chair, Liver Tumor Branch, Chinese Medical and Health International Exchange Promotion Association
• Vice President, Anhui Medical Association
• Chair, Anhui Hospital Performance Management Committee
• Deputy Chair, General Surgery Committee and Chair, Hepatobiliary Surgery Committee, Heilongjiang Medical Association

International Recognition:

• Distinguished Professor, "Longjiang Scholars" Program
• Fellow, American College of Surgeons (FACS)
• Member, International Hepato-Pancreato-Biliary Association (IHPBA)
• Founding Member, International Laparoscopic Liver Society (ILLS)
• Member, International Association of Surgeons, Gastroenterologists and Oncologists (IASGO)
• Honorary Member, British Hepato-Pancreato-Biliary Association (GIHPBA)

Managing Editor: Victoria Lee
Language Editor: Catherine Yang
Production Editor: Ting Xu

Respectfully Submitted by the Journal Editorial Office of Hepatoma Research