title: Anatomical bi- and trisegmentectomies as alternatives to extensive liver resections.
abstract: OBJECTIVE
  To assess the technical and oncologic results of anatomic hepatic bi- and trisegmentectomies.
  
  
  BACKGROUND
  Regardless of their size, some tumors require extensive hepatectomy only because they are located centrally or in the vicinity of major portal pedicles or hepatic veins. Anatomic bi- and trisegmentectomy might represent an alternative to extensive hepatectomies in such cases.
  
  
  METHODS
  Of 435 liver resections, 32 cases (7%) included 2 or 3 adjacent segments (left lateral sectionectomies, ie, bisegmentectomies 2-3, excluded). There were 16 central hepatectomies (segments 4, 5, and 8), 7 right posterior sectionectomies (segments 6 and 7) and 2 central anterior (segments 4b and 5), 1 central posterior (segments 4a and 8), 2 right superior (segments 7 and 8), 3 right inferior (segments 5 and 6), and 1 left anterior (segments 3 and 4b) bisegmentectomies. Indications were malignant disease in 29 patients, including 15 with cirrhosis and 2 with benign tumors. External landmarks, selective devascularization, and intraoperative ultrasound were used to achieve anatomic resection.
  
  
  RESULTS
  Mortality, transfusion, and morbidity rates were 0%, 26%, and 19%, respectively. Mean section margin was 9 mm (range, 1-40 mm). Isolated intrahepatic recurrence occurred in 7 patients (24%) and 3 (43%) underwent repeat hepatectomy.
  
  
  CONCLUSIONS
  Anatomic bi- or trisegmentectomy is a safe alternative to extensive liver resection in selected patients, avoiding unnecessary sacrifice of functional parenchyma and enhancing the opportunity to perform repeat resections in cases of recurrence.
authors.affiliation: Department of Digestive Surgery, Hôpital Henri Mondor-Université Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Chouillard
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
authors.forename: Claude
authors.initials: C
authors.lastname: Tayar
authors.forename: Francesco
authors.initials: F
authors.lastname: Brunetti
authors.forename: Pierre-Louis
authors.initials: PL
authors.lastname: Fagniez
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D018281:Cholangiocarcinoma / Q000601:surgery; D015179:Colorectal Neoplasms / Q000473:pathology; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies