title: Systematic extended right posterior sectionectomy: a safe and effective alternative to right hepatectomy.
abstract: BACKGROUND
  A surgical approach based on ultrasound-guided hepatectomy might minimize the need for major resection, whose rates of morbidity and mortality are not negligible. Right hepatectomy (RH) is traditionally performed in cases of vascular invasion of the right hepatic vein with multiple tumors in the right posterior section, and/or of the right posterior portal branch (P6-7) with tumor in contact with right anterior portal branch (P5-8). We herein describe an alternative approach to RH consisting in ultrasound-guided systematic extended right posterior hepatic sectionectomy (SERPS).
  
  
  METHODS
  Among 207 consecutive patients who underwent hepatectomies, 21 (10%) underwent SERPS. Median age was 67 years (range, 48-79). There were 13 men and 8 women. Ten (48%) patients had hepatocellular carcinoma; 11 (52%) had colorectal liver metastases. Median tumor number was 2 (range, 1-15); median tumor size was 4.5 cm (range, 2.5-20). Ten (48%) patients had cirrhosis, 8 (38%) had steatosis, and 3 (16%) had normal liver. Surgical strategy was based on tumor-vessels relationship at intraoperative ultrasonography (IOUS) and on findings at color-Doppler IOUS.
  
  
  RESULTS
  In-hospital and 90-days mortality were nil. Major and minor morbidity occurred in 3 (14%) and 2 (9.5%) patients, respectively. No patients were reoperated because of complications. Blood transfusions were given to 2 (9.5%) patients. After a median follow-up of 21 months, no local recurrence was observed.
  
  
  CONCLUSIONS
  IOUS-guided SERPS is feasible, safe, and effective. It should be applied whenever possible as alternative resection to RH to maximize liver parenchymal sparing.
authors: Third Department of General Surgery, University of Milan, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy. guido.torzilli@unimi.it
authors: Guido
authors: G
authors: Torzilli
authors: Matteo
authors: M
authors: Donadon
authors: Matteo
authors: M
authors: Marconi
authors: Florin
authors: F
authors: Botea
authors: Angela
authors: A
authors: Palmisano
authors: Daniele
authors: D
authors: Del Fabbro
authors: Fabio
authors: F
authors: Procopio
authors: Marco
authors: M
authors: Montorsi
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000601:surgery; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D014463:Ultrasonography