title: Null-margin bisegmentectomy VII-VIII for hepatocellular carcinoma in cirrhotic patients.
abstract: OBJECTIVE
  Preservation of functional liver parenchyma should be a priority in hepatic surgery to avoid postoperative liver failure and enhance the opportunity to perform repeat resection in case of tumor recurrence.
  
  
  METHODS
  A tumor localized in segments VII, VIII and adhering to or compressing the middle hepatic vein sometimes indicates a need to perform bisegmentectomy VII-VIII without surgical margin. From June 2006 to June 2011, fourteen patients with such a tumor underwent null-margin bisegmentectomy VII-VIII in our hospital. We retrospectively review our experience with this uncommon and technique-challenging hepatic resection.
  
  
  RESULTS
  Mean intraoperative blood loss was estimated to be 300 mL and only four patients required blood transfusions less than 4U each person. Mean postoperative hospitalization was 11.2 days. Postoperative complications were encountered in 28.5% of patients and there was no postoperative mortality. Median overall and disease-free survivals were 35 and 23 months, respectively.
  
  
  CONCLUSIONS
  The lack of ability to obtain an adequate surgical margin should not be considered as a contraindication for hepatectomy of HCC. In patients with impaired liver functional reserve and with right superiorly located tumors, the preservation of the middle hepatic vein should take priority and null-margin bisegmentectomy VII-VIII for HCC should be recommended.
authors.affiliation: Department of General Surgery, XiangYa Second Hospital, Hunan Province, China.
authors.forename: Jiang-Sheng
authors.initials: JS
authors.lastname: Huang
authors.forename: Wei-Dong
authors.initials: WD
authors.lastname: Dai
authors.forename: Xiong-Ying
authors.initials: XY
authors.lastname: Miao
authors.forename: De-Wu
authors.initials: DW
authors.lastname: Zhong
authors.forename: Shou-Zhi
authors.initials: SZ
authors.lastname: Xiong
authors.forename: Ji-Xiong
authors.initials: JX
authors.lastname: Hu
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002681:China; D018572:Disease-Free Survival; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006503:Hepatic Veins / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome