The clinical study of precise hemihepatectomy guided by middle hepatic vein.
OBJECTIVE
This study was designed to analyze the feasibility of classification for hepatic veins preoperatively and to evaluate the safety and therapeutic efficacy of precise hemihepatectomy guided by middle hepatic vein.


METHODS
Thirty patients who underwent precise hemihepatectomy (PH group) were subjected to multi-slice helical CT hepatic venography preoperatively to achieve Nakamura's and Kawasaki's classification of hepatic veins. The hemihepatectomy was performed precisely by the guidance of middle hepatic vein, which was revealed by the hepatic venography and confirmed with intraoperative ultrasound. The clinical data of these patients were compared with other 38 traditional hemihepatectomy patients (control group). The amount of intraoperative bleeding and blood transfusion, liver function recovery, postoperative complications, and 1-year follow-up data were compared between two groups.


RESULTS
The ratios of Nakamura's classification type I, II, and III of hepatic veins were 56.7 % (17/30), 26.7 % (8/30), and 16.7 % (5/30), respectively; The percentages of Kawasaki's classification type I and II of hepatic veins were 36.7 % (11/30) and 63.3 % (19/30), respectively. The total 30 cases of precise hemihepatectomies were performed successfully, including 13 cases of right hemihepatectomy without MHV, 15 cases of left hemihepatectomy without MHV, 1 case of right hemihepatectomy with MHV, and 1 case of left hemihepatectomy with MHV. There was no significant difference in operation-related mortality, the amount of intraoperative bleeding and blood transfusion, as well as serum alanine aminotransferase, total bilirubin, and cholinesterase of the third postoperative day between the two groups. However, negative resection margin and albumin level were more favorable in precise hemihepatectomy group than control group. In addition, the incidence of postoperative pleural effusion and seroperitoneum was decreased significantly in precise hemihepatectomy group. The 1-year, tumor-free survival rate was 79 % (15/19) In PH group, which is 48 % in control group.


CONCLUSIONS
Preoperative evaluation of hepatic veins is of great value for individual operative program via determination of anatomical type of hepatic veins. Precise hemihepatectomy could preserve functional liver tissue with complete venous return to a great extent, resulting in fewer incidences of postoperative pleural effusion and seroperitoneum. Precise hemihepatectomy also has the potential to achieve more adequate tumor-free resection margin, which may result in higher tumor-free survival rate.
Department of Hepatobiliary Surgery, The Affiliated DrumTower Hospital of Nanjing University Medical School, Nanjing, 210008, China.
Yudong
Y
Qiu
Xinhua
X
Zhu
Rixiang
R
Zhu
Jianxin
J
Zhou
Tie
T
Zhou
Yang
Y
Wang
Yitao
Y
Ding
D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D036542:Tomography, Spiral Computed