Hepatectomy preserving drainage veins of the posterior section for liver malignancy invading the right hepatic vein: an alternative to right hepatectomy

• Published in: The American journal of surgery 2012-11, Vol.204 (5), p.717-723
• Main Authors: Shimizu, Akira, M.D., Ph.D, Kobayashi, Akira, M.D., Ph.D, Yokoyama, Takahide, M.D., Ph.D, Nakata, Takenari, M.D., Ph.D, Motoyama, Hiroaki, M.D., Ph.D, Kubota, Koji, M.D., Ph.D, Furusawa, Norihiko, M.D, Kitahara, Hiroe, M.D., Ph.D, Kitagawa, Noriyuki, M.D, Fukushima, Kentaro, M.D, Shirota, Tomoki, M.D, Miyagawa, Shinichi, M.D., Ph.D
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cardiovascular system; Color-Doppler intraoperative ultrasonography; Drainage veins of the posterior section; DVPS-preserving hepatectomy; Female; Follow-Up Studies; General aspects; Hepatectomy; Hepatectomy - methods; Hepatic Veins - diagnostic imaging; Hepatic Veins - pathology; Hepatic Veins - surgery; Hepatitis; Humans; Imaging, Three-Dimensional; Investigative techniques, diagnostic techniques (general aspects); Liver cancer; Liver cirrhosis; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - mortality; Liver Neoplasms - surgery; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Mortality; Postoperative Complications - epidemiology; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Three-dimensional computed tomography; Tomography, X-Ray; Treatment Outcome; Ultrasonic investigative techniques; Ultrasonography, Doppler, Color; Ultrasonography, Interventional; Veins & arteries; Volumetric analysis
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2012.02.011

Abstract Background Although a right hepatectomy (RH) traditionally has been performed for liver tumors infiltrating the main trunk of the right hepatic vein (RHV), the presence of drainage veins of the posterior section (DVPS) beside the RHV provides a chance to preserve their draining area even if the main trunk of the RHV is removed. Methods Since 2005, we systematically have performed DVPS-preserving hepatectomies whenever possible. In the present study, we describe our experience treating 12 consecutive patients who underwent this procedure. Results We performed the following types of liver resections concomitant with the main trunk of the RHV without packed red cell transfusion, liver failure, or 90-day mortality: extended right anterior sectionectomy in 2 patients, extended segmentectomy 7 in 3, extended segmentectomy 8 in 2, and partial resection of segment 7 in 2 and segment 8 in 3. Postoperative morbidity was observed in 4 (33%) cases, all of which had pleural effusion requiring a tap. A free resection margin was obtained in all patients. Conclusions This procedure could be a useful alternative to RH, providing a chance for radical liver resection with minimal parenchymal sacrifice in selected patients with DVPS.