Clinical analysis of right anterior segmentectomy for hepatic malignancy.
OBJECTIVE
Combined resection of segments 5 and 8, or right anterior segmentectomy, is one of the most difficult hepatic resections because of the danger of bleeding from the two major hepatic veins, the middle and right hepatic veins, during hepatectomy. We describe here the operative procedure and clinical analysis of right anterior segmentectomy in 35 patients with hepatic malignancy.


METHODS
Between March 1993 and December 2004, 35 patients underwent right anterior segmentectomy for hepatic malignancy. The technique used was based on the extraglissonian approach and parenchymal Kelly crushing, during which the two major hepatic veins were almost fully exposed.


RESULTS
Thirty-three patients had hepatocellular carcinoma, one had peripheral cholangiocellular carcinoma, and one had primary hepatic sarcoma. The mean operation time was 331 +/- 73 minutes and the mean transfusion of packed RBC was 1.09 +/- 1.57 pints. There was one in-hospital death as a result of sepsis and hepatic failure. The cumulative 1-, 2- and 5-year survival rates were 94%, 72% and 62%, respectively.


CONCLUSIONS
For surgeons who accurately know the anatomy of the liver, this procedure is safe and suitable in selected patients with hepatic malignancies and may increase the survival rate.
Kim
Ki Hun
KH
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. khkim620@amc.seoul.kr
Kim
Hee Sung
HS
Lee
Young Joo
YJ
Park
Kwang Min
KM
Hwang
Shin
S
Ahn
Chul Soo
CS
Moon
Deok Bog
DB
Ha
Tae Yong
TY
Kim
Yeon Dae
YD
Kim
Kun Kook
KK
Song
Ki Won
KW
Choi
Sang Tae
ST
Kim
Dong Sik
DS
Jung
Dong Hwan
DH
Lee
Sung Gyu
SG
D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality; D016896:Treatment Outcome