Abstract
The majority of hepatocellular carcinomas are complicated by liver cirrhosis. Cirrhotic patients with a tumor located in segments 7 and 8 cannot tolerate right lobectomy. To perform curative resection without causing liver failure in such patients, resection of segments 7 and 8, together with resection of the right hepatic vein, is recommended. Nine patients underwent such resection. In four patients, the right hepatic vein was not reconstructed. One patient died of liver failure and the other two patients had postoperative liver dysfunction. Based on this experience, the right hepatic vein was reconstructed in the remaining five patients; the defect was repaired by transplanting a vein graft in three patients, and a patch graft was carried out in two. In one patient who underwent reconstruction with vein graft, veno-venous bypass was performed between the remnant hepatic vein and inferior vena cava. This procedure decompressed the remnant liver and facilitated secure anastomosis in reconstruction of the hepatic vein. There were no complications or deaths. The reconstructed veins were patent 2–3 years postoperatively. This procedure is feasible and valid, and should be widely practiced in patients with a diminished liver function reserve.
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Makuuchi M, Hasegawa H, Yamazaki S, Takayasu K (1987) Four new hepatectomy procedures for resection of the right hepatic vein and preservation of the inferior right hepatic vein. Surg Gynecol Obstet 164:68–72
Nakamura S, Tsuzuki T (1981) Surgical anatomy of the hepatic veins and the inferior vena cava. Surg Gynecol Obstet 152:43–50
Kanematsu T, Takenaka K, Matsumata T, Furuta T, Sugimacki K, Inokuchi K (1984) Limited hepatic resection effective for selected cirrhotic patients with primary liver cancer. Ann Surg 199:51–56
Kasajima M, Tsuzuki T, Tashiro M, Ito H (1989) Clinico-pathological study on spread of hepatocellular carcinoma (in Japanese). Gan no Rinsho (Jpn J Cancer Ciin) 35:669–676
Sugioka A, Tsuzuki T, Kanai T (1993) Postresection prognosis of patients with hepatocellular carcinoma. Surgery 113:612–618
Ou QJ, Herman RE (1987) Hepatic vein ligation and preservation of liver segments in major resections. Arch Surg 122:1198–1200
Kitazawa T, Nakamura S, Muro H (1988) Clinical and experimental studies on ligation of the draining vein in the remnant liver during hepatectomy (in Japanese). J Jpn Surg Congress 89:863–870
Tanaka K, Uemoto S, Tokunaga Y, Fujita S, Sano K, Nishizawa T, Sawada H, Shirase I, Kim HJ, Yamaoka Y, Ozawa K (1993) Surgical techniques and innovations in living-related liver transplantation. Ann Surg 217:82–91
Emond JC, Heffron TG, Whitington PF, Broelsch CE (1993) Reconstruction of the hepatic vein in reduced size hepatic transplantation. Surg Gynecol Obstet 176:11–17
Nakamura S, Sakaguchi S, Hachiya T, Suzuki S, Nishiyama R, Konno H, Muro H, Baba S (1993) Significance of hepatic vein reconstruction in hepatectomy. Surgery 114:59–64
Couinaud C (1957) Le foie, Etudes anatomicales et chirurgicales. Paris: Masson & Cie.
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Nakamura, S., Nishiyama, R., Serizawa, A. et al. Feasibility and validity of hepatic vein reconstruction in hepatectomy for hepatocellular carcinoma. J Hep Bil Pancr Surg 1, 128–132 (1994). https://doi.org/10.1007/BF01222235
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DOI: https://doi.org/10.1007/BF01222235