Surgical Approach to “Right Hepatic Core”: Deepest Region Surrounded by Major Portal Pedicles and Right Hepatic Vein

Tani, Kazuhide; Ishizawa, Takeaki; Sakamoto, Yoshihiro; Hasegawa, Kiyoshi

doi:10.1159/000485138

Cited by 5 publications

(3 citation statements)

References 23 publications

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“…4 -6,27-30 On the other hand, studies that focused on single MiHs have reported detailed outcomes. 8,[17][18][19][30][31][32][33][34][35][36][37][38][39] However, those studies involved single centers with a limited number of patients, and they reported feasibility and safety of the procedure, rather than its position in surgical practice. The present analysis was the first to provide a broad perspective on different MiHs.…”

Section: Discussionmentioning

confidence: 99%

Minor Hepatectomies: Focusing a Blurred Picture

et al. 2019

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To elucidate minor hepatectomy (MiH) outcomes. Summary Background Data: Liver surgery has moved toward a parenchyma-sparing approach, favoring MiHs over major resections. MiHs encompass a wide range of procedures. Methods: We retrospectively evaluated consecutive patients who underwent open liver resections in 17 high-volume centers. Exclusion criteria: cirrhosis and associated digestive/biliary resections. Resections were classified as (Brisbane nomenclature): limited resections (LR); (mono)segmentectomies/bisegmentectomies (Segm/Bisegm); right anterior and right posterior sectionectomies (RightAnteriorSect/RightPosteriorSect). Additionally, we defined: complex LRs (ComplexLR ¼ LRs with exposed vessels); posterosuperior segmentectomies (PosteroSuperiorSegm ¼ segment (Sg)7, Sg8, and Sg7þSg8 segmentectomies); and complex core hepatectomies (ComplexCoreHeps ¼ Sg1 segmentectomies and combined resections of Sg4sþSg8þSg1). Left lateral sectionectomies (LLSs, n ¼ 442) and right hepatectomies (RHs, n ¼ 1042) were reference standards. Outcomes were adjusted for potential confounders. Results: Four thousand four hundred seventy-one MiHs were analyzed. Compared with RHs, MiHs had lower 90-day mortality (0.5%/2.2%), severe morbidity (8.6%/14.4%), and liver failure rates (2.4%/11.6%, P < 0.001), but similar bile leak rates. LR and LLS had similar outcomes. ComplexLR and Segm/Bisegm of anterolateral segments had higher bile leak rates than LLS rates (OR ¼ 2.35 and OR ¼ 3.24), but similar severe morbidity rates.ComplexCoreHeps had higher bile leak rates than RH rates (OR ¼ 1.94); the severe morbidity rate approached that of RH. PosteroSuperiorSegm, RightAnteriorSect, and RightPosteriorSect had severe morbidity and bile leak rates similar to RH rates. MiHs had low liver failure rates, except RightAnteriorSect (vs LLS OR ¼ 4.02). Conclusions: MiHs had heterogeneous outcomes. Mortality was low, but MiHs could be stratified according to severe morbidity, bile leak, and liver failure rates. Some MiHs had postoperative outcomes similar to RH.

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Section: Discussionmentioning

confidence: 99%

Minor Hepatectomies: Focusing a Blurred Picture

et al. 2019

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“…However, the surgical field becomes deep and restricted by the surrounding liver parenchyma overlying the hepatic hilum. Tani et al (28) reported resections of deeply located tumors in combination with adjacent segments, such as segment 6, 7, or 8, to preserve the liver parenchyma. This approach is very effective when the tumor does not invade the major hepatic veins or hepatic hilum.…”

Section: Discussion Discussionmentioning

confidence: 99%

Central Hepatectomy Using the Hilar Approach for Removal of Tumors in the Paracaval Portion of the Caudate Lobe

Maki¹,

Sakamoto²,

Shinkawa³

et al. 2019

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Safe hepatectomy for the paracaval portion of the caudate lobe is technically demanding. We propose central hepatectomy using the hilar approach for resection of the paracaval portion.The right liver with the caudate lobe was totally mobilized from the inferior vena cava. Central hepatectomy with or without middle hepatic vein (MHV) resection was performed by dividing the right anterior and left medial sections vertically toward the inferior vena cava. The bilateral Glissonian pedicles were widely exposed (hilar approach), and the liver parenchyma including the paracaval portion of the liver was removed with a good surgical view.This procedure was performed in four patients with hepatocellular carcinoma, one patient with intrahepatic cholangiocarcinoma, and one patient with colorectal liver metastasis. Combined resection of the MHV was performed in four patients, and removal of the tumor thrombus in the bile duct was performed in one patient. The median operation time was 439 minutes, and the median blood loss was 800 ml. The resected liver parenchyma was12.0% (range, 4.7%-39.5%) of the total liver volume. No patients developed postoperative liver failure. Central hepatectomy using the hilar approach is a safe, parenchyma-preserving surgical procedure for removal of tumors located in the paracaval portion.

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“…В настоящее время это требование полностью утратило свое значение [3]. Ряд вопросов, в свою очередь, остаются нерешенными и теперь, один из наиболее сложных -планирование объема оперативного вмешательства при расположении новообразований в проекции крупных магистральных сосудов печени [4]. Риск нарушения кровоснабжения и (или) оттока крови, даже зачастую при небольших размерах образования, толкает хирурга на удаление значительной части паренхимы печени.…”

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Resecting liver segments VII–VIII without reconstructing the right hepatic vein

et al. 2022

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Aim. To improve outcomes of treatment for neoplasms in segments VII-VIII of the liver adjacent to the main stem of the right hepatic vein and/or to its forming large branches.Materials and methods. In the period of 2016–2022, the resection of segments VII and/or VIII of the liver and the right hepatic vein, as well as its forming branches without reconstruction was performed in 24 patients. Surgical indications were liver metastases of colorectal cancer in 15 cases, hepatocellular cancer (cholangiocarcinoma) in six cases, angiomyolipoma in one case, uterine cancer metastases in one case and primary retroperitoneal tumor metastases in one case. Minor liver resections were additionally performed in 11 cases. Results. There were no intraoperative signs of impaired venous drainage. After surgery bile in the drains was detected in three patients, and a biliary fistula was formed in one case. No other complications were identified. No fatalities were registered after surgery. The late postoperative period revealed no specific complications related to a disturbance of venous drainage through the right hepatic vein.Conclusion. Existing and emerging collaterals can provide adequate venous drainage to the middle hepatic vein, short hepatic veins after resection of liver segments VII and VIII with resection of the right hepatic vein stem and its forming branches without reconstruction, even if the lower right hepatic vein is missing, and without complete obstruction of the right hepatic vein before surgery.

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Surgical Approach to “Right Hepatic Core”: Deepest Region Surrounded by Major Portal Pedicles and Right Hepatic Vein

Cited by 5 publications

References 23 publications

Minor Hepatectomies: Focusing a Blurred Picture

Minor Hepatectomies: Focusing a Blurred Picture

Central Hepatectomy Using the Hilar Approach for Removal of Tumors in the Paracaval Portion of the Caudate Lobe

Resecting liver segments VII–VIII without reconstructing the right hepatic vein

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