Abstract
Background
Liver resection represents a most effective treatment for hepatocellular carcinoma (HCC). The extent of hepatectomy for HCC involves maintaining a tricky balance between radical resection of tumors and preservation of sufficient liver parenchyma. Generally, removal of the right hepatic vein often involves resection of the whole posterior right lobe, which may prevent patients with impaired liver function from maintaining a functional reserve and could also limit the future liver remnant from curative hepatectomy. As a common anatomic variation, preservation of the inferior right hepatic vein (IRHV) may enable preservation of liver segment 6, even when the right hepatic vein has to be removed. In the present study, we report our experience with IRHV-preserving major right hepatectomy.
Methods
From February 2009 to December 2011, eight trisegmentectomies 5-7-8 and two segmentectomies 4-5-7-8 were performed with the IRHV-sparing technique on patients with HCC and significant fibrosis or cirrhosis. Data including demographic information, preoperative evaluations, postoperative outcomes, and follow-up results were collected and evaluated.
Results
All patients survived and recovered from hepatectomy. The incidence of complications was higher in cirrhotic patients. The 1-year overall survival rate was 80 %, and the 1-year disease free survival rate was 60 %.
Conclusions
IRHV-preserving major right hepatectomy increases the resectability of HCC. Intraoperative ultrasonography is recommended to facilitate protection of the IRHV. This technique is safe with careful preoperative evaluation and meticulous perioperative care. The short-term outcome of IRHV-preserving liver resections is satisfactory.
Similar content being viewed by others
References
Poon RT, Fan ST, Lo CM et al (2001) Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg 234:63–70
Lim KC, Chow PK, Allen JC et al (2012) Systematic review of outcomes of liver resection for early hepatocellular carcinoma within the Milan criteria. Br J Surg 99:1622–1629
Poon RT, Fan ST (2004) Hepatectomy for hepatocellular carcinoma: patient selection and postoperative outcome. Liver Transpl 10:S39–S45
Fan ST, Lo CM, Liu CL et al (1999) Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg 229:322–330
Jarnagin WR, Gonen M, Fong Y et al (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 236:397–406 discussion 406–397
Schindl MJ, Redhead DN, Fearon KC et al (2005) The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut 54:289–296
Shoup M, Gonen M, D’Angelica M et al (2003) Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg 7:325–330
Okuda K (1986) Primary liver cancer. Quadrennial review lecture. Dig Dis Sci 31:133S–146S
Fan ST (2010) Liver functional reserve estimation: state of the art and relevance for local treatments: the eastern perspective. J Hepatobiliary Pancreat Sci 17:380–384
Fan ST, Lai EC, Lo CM et al (1995) Hospital mortality of major hepatectomy for hepatocellular carcinoma associated with cirrhosis. Arch Surg 130:198–203
Poon RT, Fan ST, Lo CM et al (2002) Extended hepatic resection for hepatocellular carcinoma in patients with cirrhosis: is it justified? Ann Surg 236:602–611
Kubota K, Makuuchi M, Kusaka K et al (1997) Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology 26:1176–1181
Azoulay D, Castaing D, Krissat J et al (2000) Percutaneous portal vein embolization increases the feasibility and safety of major liver resection for hepatocellular carcinoma in injured liver. Ann Surg 232:665–672
Makuuchi M, Hasegawa H, Yamazaki S et al (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
Pugh RN, Murray-Lyon IM, Dawson JL et al (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646–649
Batts KP, Ludwig J (1995) Chronic hepatitis. An update on terminology and reporting. Am J Surg Pathol 19:1409–1417
Kamath PS, Kim WR, Advanced Liver Disease Study Group (ALDS) (2007) The model for end-stage liver disease (MELD). Hepatology 45:797–805
Llovet JM, Brú C, Bruix J (1999) Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 19:329–338
Rahbari NN, Garden OJ, Padbury R et al (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149:713–724
Xing X, Li H, Liu WG (2007) Clinical studies on inferior right hepatic veins. Hepatobiliary Pancreat Dis Int 6:579–584
Fang CH, You JH, Lau WY et al (2012) Anatomical variations of hepatic veins: three-dimensional computed tomography scans of 200 subjects. World J Surg 36:120–124. doi:10.1007/s00268-011-1297-y
De Cecchis L, Hribernik M, Ravnik D et al (2000) Anatomical variations in the pattern of the right hepatic veins: possibilities for type classification. J Anat 197(Pt 3):487–493
Makuuchi M, Hasegawa H, Yamazaki S et al (1983) The inferior right hepatic vein: ultrasonic demonstration. Radiology 148:213–217
Machado MA, Bacchella T, Makdissi FF et al (2008) Extended left trisectionectomy severing all hepatic veins preserving segment 6 and inferior right hepatic vein. Eur J Surg Oncol 34:247–251
de Lope CR, Tremosini S, Forner A et al (2012) Management of HCC. J Hepatol 56(Suppl 1):S75–S87
Cauchy F, Fuks D, Belghiti J (2012) HCC: current surgical treatment concepts. Langenbecks Arch Surg 397:681–695
Guglielmi A, Ruzzenente A, Conci S et al (2012) How much remnant is enough in liver resection? Dig Surg 29:6–17
Saner FH, Heuer M, Meyer M et al (2009) When the heart kills the liver: acute liver failure in congestive heart failure. Eur J Med Res 14:541–546
Kishi Y, Abdalla EK, Chun YS et al (2009) Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Ann Surg 250:540–548
Imamura H, Seyama Y, Kokudo N et al (2003) One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 138:1198–1206 (discussion 1206)
Fan ST (2002) Methods and related drawbacks in the estimation of surgical risks in cirrhotic patients undergoing hepatectomy. Hepatogastroenterology 49:17–20
Chouillard E, Cherqui D, Tayar C et al (2003) Anatomical bi- and trisegmentectomies as alternatives to extensive liver resections. Ann Surg 238:29–34
Machado MA, Herman P, Meirelles RF Jr et al (2005) How I do it: bi-segmentectomy V–VIII as alternative to right hepatectomy: an intrahepatic approach. J Surg Oncol 90:43–45
Hsu K-Y, Chau G-Y, Lui W-Y et al (2009) Predicting morbidity and mortality after hepatic resection in patients with hepatocellular carcinoma: the role of model for end-stage liver disease score. World J Surg 33:2412–2419. doi:10.1007/s00268-009-0202-4
Cucchetti A, Ercolani G, Vivarelli M et al (2006) Impact of model for end-stage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis. Liver Transpl 12:966–971
Yamanaka N, Okamoto E, Kawamura E et al (1993) Dynamics of normal and injured human liver regeneration after hepatectomy as assessed on the basis of computed tomography and liver function. Hepatology 18:79–85
Bernardi M (2010) Spontaneous bacterial peritonitis: from pathophysiology to prevention. Intern Emerg Med 5(Suppl 1):S37–S44
Cucchetti A, Ercolani G, Vivarelli M et al (2009) Is portal hypertension a contraindication to hepatic resection? Ann Surg 250:922–928
Capussotti L, Ferrero A, Viganò L et al (2006) Portal hypertension: contraindication to liver surgery? World J Surg 30:992–999. doi:10.1007/s00268-005-0524-9
Santambrogio R, Kluger MD, Costa M et al (2013) Hepatic resection for hepatocellular carcinoma in patients with Child-Pugh’s A cirrhosis: is clinical evidence of portal hypertension a contraindication? HPB (Oxf) 15:78–84
Kanematsu T, Takenaka K, Furuta T et al (1985) Acute portal hypertension associated with liver resection. Analysis of early postoperative death. Arch Surg 120:1303–1305
Acknowledgments
This study was supported by Grants for Key Clinical Centers and Institutes (No. ZX201105), the Scientific Research Foundation of Graduate School of Nanjing University (No. 2013CL14) and the Science Fund of the Ministry of Health of China (No. LW201008).
Conflict of interest
The authors declared no conflict of interest
Author information
Authors and Affiliations
Corresponding author
Additional information
Chunping Jiang, Zhongxia Wang, and Qingxiang Xu have contributed equally to this work.
Rights and permissions
About this article
Cite this article
Jiang, C., Wang, Z., Xu, Q. et al. Inferior Right Hepatic Vein-preserving Major Right Hepatectomy for Hepatocellular Carcinoma in Patients with Significant Fibrosis or Cirrhosis. World J Surg 38, 159–167 (2014). https://doi.org/10.1007/s00268-013-2240-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-013-2240-1