Researchers from the Department of Surgical Oncology, Dr BRA-IRCH, AIIMS Delhi, have found out that there is a small high-risk area located at the junction of the liver and inferior vena cava, which has been named "Ray's triangle." This research emphasizes the need for full mobilization of the liver and examination of the hidden areas behind the liver during extensive surgeries on the abdomen for cancers. This research, conducted by Dr M D Ray and MCh student Dr Anik Rathee, has examined 205 cases of ovarian cancer patients with extensive liver mobilization at AIIMS between January 2014 and December 2025.
According to the researchers, there are deposits of cancer that could be present beneath the liver, along the diaphragm, behind the liver, or in other hard-to-access areas and which might not always be seen through scans. The mobilization of the liver gives the surgeon access to such areas where the cancer can be cut out. The removal of all visible cancer was pointed out by the study as an important factor that is linked with higher rates of survival for ovarian cancer.
From the total number of 205 patients who were studied, a complete removal of cancer or close to complete was attained in 194 patients, which is equivalent to 94.6 percent. Of the 194 patients, 178 attained complete removal of visible disease, and 16 of them had residual disease.
Ray's triangle was stated to be a warning region in surgery where the vein, liver, and inferior vena cava join together. It was pointed out by the researchers that this is not an anatomically named region; instead, it is a region that needs special attention during mobilisation of the liver.
Another finding of the study is that injuries to the right hepatic vein were found in nine people, making up 4.4% of the total population studied. In the first 100 people, seven cases of injury were noted, while only two cases were observed among the next 105 patients. Even though there has been a decrease in the injury rate, from 7% to 1.9%, it was noted by the researchers that it is inconclusive in statistical terms.
As per the authors, the risk of injuring the vasculature can be decreased by a structured surgical procedure, which involves identifying the blood vessels and gentle manipulation without any violent or blind movements during mobilisation of the liver. In two cases, dense adhesions made identification of normal planes risky; thus, the surgeons discontinued resection to prevent venous injury.
According to the results of the study, surgery for abdominal malignancies needs more than excision of visible tumors. Examination of hidden areas, liver mobilisation, and proper handling of major blood vessels in the area can help surgeons to remove visible malignancies safely.
According to Towards Healthcare, the cancer biopsy market is projected to grow significantly, with estimates indicating the market size will increase from USD 43.51 billion in 2026 to approximately USD 205.72 billion by 2035; The market is expanding at a CAGR of 18.84% between 2026 and 2035, it consists of the surgeries and technologies that have been developed for the treatment of cancerous tumors in the abdomen. The development of complicated surgeries related to oncology is helping to develop systematic approaches to cancer removal surgeries. An example of such research is the discovery of Ray's triangle, which shows the significance of knowing anatomy during such difficult surgeries.
The All India Institute of Medical Sciences, New Delhi, in association with its Department of Surgical Oncology in Dr BRA-IRCH, undertook the study regarding liver mobilisation during complex abdominal cancer surgery. The department offers surgical oncology facilities and engages in research concerning major and complex cancer surgery. The study was undertaken by Dr M D Ray and Dr Anik Rathee, an MCh student.
