Clinical feasibility of inferior right hepatic vein-preserving trisegmentectomy 5, 7, and 8 (with video).
OBJECTIVE
Hepatic resection involves not only complete removal of tumors but also preservation of optimal liver function after surgery. This study introduces the technique of inferior right hepatic vein (IRHV)-preserving trisegmentectomy 5, 7, and 8 and evaluates its clinical feasibility.


METHODS
Between January 2008 and December 2011, four patients underwent this procedure. Postoperative outcomes and interim results were evaluated.


RESULTS
The median estimated volumes of the left lobe only and the left lobe plus preserved parenchyma relative to the total estimated liver volume were 22.8 % (range, 21.1-24.2 %) and 43.6 % (range, 38.0-47.5 %), respectively. The median total operating time and blood loss were 349 min (range, 348-417 min) and 650 ml (range, 300-1,700 ml), respectively. One patient developed the postoperative complication of bile leakage. The median hospital stay was 14.5 days (range, 14-50 days). Median follow-up was 23.5 months (range, 6-70 months), and two patients developed recurrence. One patient died of disease progression, and the other three patients were alive at the last follow-up.


CONCLUSIONS
Based on our experience, IRHV-preserving trisegmentectomy 5, 7, and 8 is a safe and feasible procedure. This technique could be an option for curative resection minimizing postoperative deterioration of liver function without preoperative portal vein embolization in patients with a reliable IRHV.
Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Ludlow Faculty Research Building, 50 Yonsei-ro, Seodaemoon-gu, Seoul, 120-752, Korea.
Sung Hoon
SH
Choi
Gi Hong
GH
Choi
Dai Hoon
DH
Han
Jin Sub
JS
Choi
Woo Jung
WJ
Lee
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery; D018281:Cholangiocarcinoma / Q000601:surgery; D015179:Colorectal Neoplasms / Q000556:secondary / Q000601:surgery; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D061646:Operative Time; D059351:Organ Sparing Treatments / Q000009:adverse effects; D049268:Positron-Emission Tomography; D012189:Retrospective Studies
D003287:Contrast Media