Anatomic trisegmentectomy: An alternative treatment for huge or multiple hepatocellular carcinoma of right liver.
BACKGROUND
The patients with huge (≥10cm) or multiple hepatocellular carcinoma (HCC) in the right liver and insufficient size of the remnant left liver can not be performed an operation of right hemihepatectomy because of that liver failure will occur post operation. We designed anatomic trisegmentectomy in right liver to increase the ratio of future liver remnant volume (%FLRV), thus increasing resectability of huge or multiple HCC.


METHODS
Thirteen patients were analyzed by preoperative CT scan for liver and tumor volumetries. If the right hemihepatectomy was done, %FLRV would be at the range of 29.6%-37.5%. However, if trisegmentectomy was done, %FLRV would increase by an average of 14.0%. So patients will not undergo postoperative liver failure due to sufficient %FLRV. Therefore, we designed anatomic trisegmentectomy, with retention of segment 5 or segment 8, to increase %FLRV and increase the resectability for huge or multiple HCC.


RESULTS
After trisegmentectomy, the inflow and outflow of remnant liver were maintained well. Severe complications and mortality were not happened post operation. Of the 13 patients, 10 survived up to now. Of the 10 living cases, postoperative lung metastasis was found in 2 and intrahepatic recurrence was found in 1. These 3 patients survive with tumor after comprehensive therapies including oral administration of Sorafenib.


CONCLUSIONS
Compared to right hemihepatectomy, anatomic trisegmentectomy in right liver guarantees the maximum preservation of %FLRV to increase the resectability of huge or multiple HCC, thus improving the overall resection rate.
Department of Hepatobiliary Pancreatic Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou 310006, China. Electronic address: changkujia@163.com.
Changku
C
Jia
Department of Hepatobiliary Pancreatic Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, China.
Jie
J
Weng
Department of General Surgery, Lin'gao County Hospital of Hainan Province, Lin'gao, 570102, China.
Qifan
Q
Qin
Department of Hepatobiliary Pancreatic Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, China.
Youke
Y
Chen
Department of Hepatobiliary Pancreatic Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, China.
Xiaolong
X
Huang
Department of Hepatobiliary Pancreatic Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, China.
Yu
Y
Fu
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000601:surgery*; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D016896:Treatment Outcome
Anatomic segmentectomy; Hepatocellular carcinoma; Liver volume; Respectability