title: Surgical Indications and Procedures for Resection of Hepatic Malignancies Confined to Segment VII.
abstract: OBJECTIVE
  To establish a strategy for surgical resection of hepatic malignancies confined to segment VII.
  
  
  BACKGROUND
  Various surgical procedures can be used to resect hepatic malignancies in segment VII, the deepest region of the liver, by open and/or laparoscopic approaches: nonanatomic wedge resection (WR), segmentectomy VII, right lateral sectionectomy (RLS), and right hepatectomy.
  
  
  METHODS
  WR and segmentectomy VII were applied as first-line surgical procedures for colorectal liver metastasis (CRLM) and hepatocellular carcinoma (HCC), respectively. RLS and right hepatectomy were indicated only when tumor infiltration to the proximal Glissonian sheath was suspected. Operative outcomes were evaluated in 200 consecutive patients who underwent hepatic resection for HCC (n = 120) or CRLM (n = 80).
  
  
  RESULTS
  WR, segmentectomy VII, RLS, and right hepatectomy were performed in 104 (52.0%), 57 (28.5%), 22 (11.0%), and 17 (8.5%) patients, respectively. Local hepatectomy (WR and segmentectomy VII) led to shorter operation times and lower blood loss volumes than did extensive hepatectomy (RLS and right hepatectomy). Thoracotomy was performed in half of the WR and two-thirds of the segmentectomy VII procedures. The availability of a laparoscopic approach was 40% (8 patients) after its application in October 2012.
  
  
  CONCLUSIONS
  Even for hepatic malignancies located in segment VII, WR and segmentectomy should be prioritized over extensive hepatectomy to preserve the postoperative functional hepatic volume. Full mobilization of the right liver and a good surgical field provided by a large thoracoabdominal or abdominal incision or a laparoscopic approach are key factors for safe performance of deep hepatic transection.
authors.affiliation: *Hepatobiliary Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan †Department of Hepatobiliary Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Creteil, France.
authors.forename: Chetana
authors.initials: C
authors.lastname: Lim
authors.forename: Takeaki
authors.initials: T
authors.lastname: Ishizawa
authors.forename: Akinori
authors.initials: A
authors.lastname: Miyata
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Mise
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D003952:Diagnostic Imaging; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome