Anatomic resection of liver segments 6-8 for hepatocellular carcinoma.
OBJECTIVE
To report the devised anatomic liver resection of segments 6, 7 and 8 to improve the resection rate for patients with right liver tumors.


METHODS
We performed anatomic liver resection of segments 6, 7 and 8 to guarantee the maximum preservation of the remaining normal liver tissue. Segment 5 was determined by two steps of Glissonean pedicle occlusion. And a "┏┛" shaped broken resection line was marked upon the diaphragmatic surface of the liver. Selective right hemihepatic inflow occlusion was used to reduce blood loss during parenchymal transection between segments 6 and 5 and between segments 8 and 5. If needed, total hepatic Glissonean pedicle occlusion was used during parenchymal transection between segment 8 and the left liver.


RESULTS
Compared to right hemihepatectomy, the percentage of future liver remnant volume was increased by an average of 13.9% if resection of segments 6, 7 and 8 was performed. Resection of segments 6, 7 and 8 was completed uneventfully. After hepatectomy, the inflow and outflow of segment 5 were maintained. There was no perioperative mortality, postoperative abdominal bleeding or bile leakage in this group. Alpha-fetoprotein (AFP) returned to the normal range within 2 mo after the operation in all the patients. One patient died 383 d postoperatively due to obstructive suppurative cholangitis. One patient suffered from severe liver dysfunction shortly after surgery and had intrahepatic recurrence 4 mo postoperatively. Postoperative lung metastasis was found in one patient. No tumor recurrence was found in the other patients and the parameters including liver function and AFP level were in the normal range.


CONCLUSIONS
Anatomic liver resection of segments 6, 7 and 8 can be a conventional operation to improve the overall resection rate for hepatocellular carcinoma.
Chang-Ku Jia, Jie Weng, You-Ke Chen, Yu Fu, Department of Hepatobiliary Pancreatic Surgery, the Affiliated Hospital of Hainan Medical College, Haikou 570102, Hainan Province, China.
Chang-Ku
CK
Jia
Chang-Ku Jia, Jie Weng, You-Ke Chen, Yu Fu, Department of Hepatobiliary Pancreatic Surgery, the Affiliated Hospital of Hainan Medical College, Haikou 570102, Hainan Province, China.
Jie
J
Weng
Chang-Ku Jia, Jie Weng, You-Ke Chen, Yu Fu, Department of Hepatobiliary Pancreatic Surgery, the Affiliated Hospital of Hainan Medical College, Haikou 570102, Hainan Province, China.
You-Ke
YK
Chen
Chang-Ku Jia, Jie Weng, You-Ke Chen, Yu Fu, Department of Hepatobiliary Pancreatic Surgery, the Affiliated Hospital of Hainan Medical College, Haikou 570102, Hainan Province, China.
Yu
Y
Fu
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000601:surgery*; D008107:Liver Diseases / Q000209:etiology; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D014057:Tomography, X-Ray Computed
Alpha-fetoprotein; Anatomic hepatectomy; Hepatocellular carcinoma; Liver tumor; Selective occlusion