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Segment 5 parenchymal sparing in extended left hepatectomy with respect to venous outflow—is it a feasible procedure?

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Abstract

Background

Segment 5 (S5) sparing liver resection for cases that require an anatomic left trisectionectomy has not been reported yet. The authors intended to verify the outcome of S5-sparing extended left hepatectomy (ELH) in respect to venous outflow.

Methods

All adult patients who underwent S5-sparing ELH between 2012 and 2017 in authors’ institute have been enrolled in this study. S5-sparring ELH was defined as resection of S2, S3, S4, and S8 with or without S1. The surgery planning was based on the images from two-dimensional triphasic computed tomography and/or magnetic resonance imaging. A three-dimensional image reconstruction and liver volumetric study were performed retrospectively.

Results

Out of 177 cases of major hepatic resection, only seven non-hilar cholangiocarcinoma patients underwent ELH during the study period. S5-sparing ELH was performed to five patients, in whom no tumor involvement in S5. The venous outflow of S5 has been maintained intraoperative, and S5 congestion has not been observed in all patients. Tailored management of the S5 venous outflow ensured an increase in functional remnant liver volume by 52.8% (range, 25.6 to 66.9%) by sparing of S5. A negative resection margin was achieved in all patients. One patient had postoperative bile leak requiring reoperation. No posthepatectomy liver failure (PHLF) has been observed.

Conclusion

S5-sparing ELH is technically feasible. Under the tailored management of S5 venous outflow, the functional future liver remnant can be increased. Further studies with larger sample size are needed to evaluate which circumstances the liver segment 5 could be preserved without venous reconstruction during the left extended hepatectomy.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Martinistr.52, 20246, Hamburg, Germany

    Jun Li, Moustafa Mohamed, Lutz Fischer & Björn Nashan

Authors
  1. Jun Li
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  2. Moustafa Mohamed
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  3. Lutz Fischer
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  4. Björn Nashan
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Contributions

J. Li: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. M. Moustafa: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. L. Fischer: study conception and design, analysis and interpretation of data, critical revision of manuscript. B. Nashan: study conception and design, analysis and interpretation of data, critical revision of manuscript.

Corresponding author

Correspondence to Jun Li.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Li, J., Mohamed, M., Fischer, L. et al. Segment 5 parenchymal sparing in extended left hepatectomy with respect to venous outflow—is it a feasible procedure?. Langenbecks Arch Surg 403, 663–670 (2018). https://doi.org/10.1007/s00423-018-1673-2

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  • DOI: https://doi.org/10.1007/s00423-018-1673-2

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