Skip to main content

Ventral Segment-Preserving Right Hepatectomy in Patients with Hepatocellular Carcinoma

Abstract

Background

Transection along the anterior fissure was proposed as a mechanism by which to open the third door of the liver. In this study, we investigated surgical outcomes of a ventral segment-preserving right hepatectomy (VSPRH) compared with those of conventional right hepatectomy in patients with hepatocellular carcinoma (HCC).

Methods

Between January 2007 and December 2010, 595 primary HCC patients underwent liver resection at the authors’ institution. Among them, the 123 HCC patients who underwent a right hepatectomy were retrospectively analyzed. The patients were classified into two groups according to the type of resection: those who underwent a VSPRH (Group A; 27 cases) and those who underwent a conventional right hepatectomy (Group B; 96 cases).

Results

In Group A, expected remnant liver volume after a right hepatectomy was calculated to be 32.1 ± 7.2 % of functional total liver volume (FTLV); remnant liver volume increased up to 54.7 ± 7.2 % of FTLV after a VSPRH. Clinicopathologic characteristics and intraoperative data did not differ between the two groups. The liver-related complication rate was higher in Group B (P = 0.02). Overall survival and disease-free survival rates were similar (3-year disease-free survival (Group A: 67.8 %; Group B: 71.7 %; P = 0.65); 3-year overall survival (Group A: 91.7 %; Group B: 87.4 %; P = 0.26). In regard to long-term synthetic function, the 1-year postoperative serum albumin level was higher in Group A.

Conclusions

A VSPRH yielded fewer liver-related complications and similar long-term oncologic outcomes, compared with conventional right hepatectomy in cirrhotic patients with a small left lobe volume. Therefore, VSPRH can be considered to be an alternative procedure for a right hepatectomy.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Healey JE Jr, Schroy PC (1953) Anatomy of the biliary ducts within the human liver; analysis of the prevailing pattern of branchings and the major variations of the biliary ducts. AMA Arch Surg 66:599–616

    Article  PubMed  Google Scholar 

  2. Couinaud C (1989) Surgical anatomy of the liver revisited. Paris (15, rue Spontini, 75116)

  3. Strasberg SM (2005) Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 12:351–355

    Article  PubMed  Google Scholar 

  4. Kogure K, Kuwano H, Fujimaki N et al (2002) Reproposal for Hjortsjo’s segmental anatomy on the anterior segment in human liver. Arch Surg 137:1118–1124

    Article  PubMed  Google Scholar 

  5. Cho A, Okazumi S, Makino H et al (2004) Anterior fissure of the right liver—the third door of the liver. J Hepatobiliary Pancreat Surg 11:390–396

    Article  PubMed  Google Scholar 

  6. Kanemura E, Togo S, Shizawa R et al (2000) Subdivision of liver anterior segment into two units according to hepatic venous drainage. Hepatogastroenterology 47:1056–1059

    CAS  PubMed  Google Scholar 

  7. Cho A, Okazumi S, Miyazawa Y et al (2004) Limited resection of the right hemiliver based on reclassification of the right anterior segment of the liver. Hepatogastroenterology 51:820–821

    PubMed  Google Scholar 

  8. Torzilli G, Donadon M, Marconi M et al (2008) Systematic extended right posterior sectionectomy: a safe and effective alternative to right hepatectomy. Ann Surg 247:603–611

    Article  PubMed  Google Scholar 

  9. Pang YY (2002) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2000; 2:333–339. HPB (Oxford) 4:99; author reply 99–100

  10. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  11. Moore KP, Wong F, Gines P et al (2003) The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology 38:258–266

    Article  PubMed  Google Scholar 

  12. Ueno S, Kubo F, Sakoda M et al (2008) Efficacy of anatomic resection vs nonanatomic resection for small nodular hepatocellular carcinoma based on gross classification. J Hepatobiliary Pancreat Surg 15:493–500

    Article  PubMed  Google Scholar 

  13. Eguchi S, Kanematsu T, Arii S et al (2008) Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey. Surgery 143:469–475

    Article  PubMed  Google Scholar 

  14. Hasegawa K, Kokudo N, Imamura H et al (2005) Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg 242:252–259

    Article  PubMed Central  PubMed  Google Scholar 

  15. Kishi Y, Hasegawa K, Kaneko J et al (2012) Resection of segment VIII for hepatocellular carcinoma. Br J Surg 99:1105–1112

    Article  CAS  PubMed  Google Scholar 

  16. Farges O, Belghiti J, Kianmanesh R et al (2003) Portal vein embolization before right hepatectomy: prospective clinical trial. Ann Surg 237:208–217

    PubMed Central  PubMed  Google Scholar 

  17. Abdalla EK, Denys A, Chevalier P et al (2004) Total and segmental liver volume variations: implications for liver surgery. Surgery 135:404–410

    Article  PubMed  Google Scholar 

  18. Tongyoo A, Pomfret EA, Pomposelli JJ (2012) Accurate estimation of living donor right hemi-liver volume from portal vein diameter measurement and standard liver volume calculation. Am J Transplant 12:1229–1239

    Article  CAS  PubMed  Google Scholar 

  19. Abdalla EK, Barnett CC, Doherty D et al (2002) Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg 137:675–680 (discussion 680–671)

    Article  PubMed  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. 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

    PubMed  Google Scholar 

  22. Lee SG, Hwang S (2005) How I do it: assessment of hepatic functional reserve for indication of hepatic resection. J Hepatobiliary Pancreat Surg 12:38–43

    Article  PubMed  Google Scholar 

  23. 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

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Tanaka K, Matsumoto C, Takakura H et al (2010) Technique of right hemihepatectomy preserving ventral right anterior section guided by area of hepatic venous drainage. Surgery 147:450–458

    Article  PubMed  Google Scholar 

  25. Yamashita Y, Hamatsu T, Rikimaru T et al (2001) Bile leakage after hepatic resection. Ann Surg 233:45–50

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Capussotti L, Ferrero A, Vigano L et al (2006) Bile leakage and liver resection: where is the risk? Arch Surg 141:690–694 (discussion 695)

    Article  PubMed  Google Scholar 

  27. Lee CC, Chau GY, Lui WY et al (2005) Risk factors associated with bile leakage after hepatic resection for hepatocellular carcinoma. Hepatogastroenterology 52:1168–1171

    PubMed  Google Scholar 

  28. Hirai I, Kimura W, Fuse A et al (2006) Evaluation of inferior right hepatic vein-preserving hepatectomy with resection of the superior right hepatic vein. Hepatogastroenterology 53:516–520

    PubMed  Google Scholar 

  29. Shimizu A, Kobayashi A, Yokoyama T et al (2012) Hepatectomy preserving drainage veins of the posterior section for liver malignancy invading the right hepatic vein: an alternative to right hepatectomy. Am J Surg 204:717–723

    Article  PubMed  Google Scholar 

  30. 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

    CAS  PubMed  Google Scholar 

  31. Machado MA, Herman P, Makdissi FF et al (2006) Feasibility of bisegmentectomy 7–8 is independent of the presence of a large inferior right hepatic vein. J Surg Oncol 93:338–342

    Article  PubMed  Google Scholar 

  32. Cho A, Okazumi S, Makino H et al (2004) Relation between hepatic and portal veins in the right paramedian sector: proposal for anatomical reclassification of the liver. World J Surg 28:8–12. doi:10.1007/s00268-003-7038-0

    Article  PubMed  Google Scholar 

  33. Torzilli G, Montorsi M, Del Fabbro D et al (2006) Ultrasonographically guided surgical approach to liver tumours involving the hepatic veins close to the caval confluence. Br J Surg 93:1238–1246

    Article  CAS  PubMed  Google Scholar 

  34. Sano K, Makuuchi M, Takayama T et al (2000) Technical dilemma in living-donor or split-liver transplant. Hepatogastroenterology 47:1208–1209

    CAS  PubMed  Google Scholar 

  35. Igami T, Yokoyama Y, Nishio H et al (2009) A left hepatectomy and caudate lobectomy combined resection of the ventral segment of the right anterior sector for hilar cholangiocarcinoma–the efficacy of PVE (portal vein embolization) in identifying the hepatic subsegment: report of a case. Surg Today 39:628–632

    Article  PubMed  Google Scholar 

  36. Poon RT, Fan ST, Lo CM et al (1999) Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors. Ann Surg 229:216–222

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  37. Choi GH, Kim DH, Kang CM et al (2008) Prognostic factors and optimal treatment strategy for intrahepatic nodular recurrence after curative resection of hepatocellular carcinoma. Ann Surg Oncol 15:618–629

    Article  PubMed  Google Scholar 

  38. Makuuchi M, Thai BL, Takayasu K et al (1990) Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 107:521–527

    CAS  PubMed  Google Scholar 

  39. Kokudo N, Makuuchi M (2004) Current role of portal vein embolization/hepatic artery chemoembolization. Surg Clin North Am 84:643–657

    Article  PubMed  Google Scholar 

  40. Nanashima A, Sumida Y, Abo T et al (2009) Clinical significance of portal vein embolization before right hepatectomy. Hepatogastroenterology 56:773–777

    PubMed  Google Scholar 

  41. Agrawal S, Belghiti J (2011) Oncologic resection for malignant tumors of the liver. Ann Surg 253:656–665

    Article  PubMed  Google Scholar 

  42. Avritscher R, Duke E, Madoff DC (2010) Portal vein embolization: rationale, outcomes, controversies and future directions. Expert Rev Gastroenterol Hepatol 4:489–501

    Article  PubMed  Google Scholar 

  43. Broering DC, Hillert C, Krupski G et al (2002) Portal vein embolization vs. portal vein ligation for induction of hypertrophy of the future liver remnant. J Gastrointest Surg 6:905–913 (discussion 913)

    Article  PubMed  Google Scholar 

  44. Liu CL, Fan ST, Cheung ST et al (2006) Anterior approach versus conventional approach right hepatic resection for large hepatocellular carcinoma: a prospective randomized controlled study. Ann Surg 244:194–203

    Article  PubMed Central  PubMed  Google Scholar 

  45. Wang CC, Jawade K, Yap AQ et al (2010) Resection of large hepatocellular carcinoma using the combination of liver hanging maneuver and anterior approach. World J Surg 34:1874–1878. doi:10.1007/s00268-010-0546-9

    Article  PubMed  Google Scholar 

  46. Wu TJ, Wang F, Lin YS et al (2010) Right hepatectomy by the anterior method with liver hanging versus conventional approach for large hepatocellular carcinomas. Br J Surg 97:1070–1078

    Article  PubMed  Google Scholar 

  47. Capussotti L, Ferrero A, Russolillo N et al (2012) Routine anterior approach during right hepatectomy: results of a prospective randomised controlled trial. J Gastrointest Surg 16:1324–1332

    Article  PubMed  Google Scholar 

  48. Lu CD, Peng SY, Jiang XC et al (1999) Preoperative transcatheter arterial chemoembolization and prognosis of patients with hepatocellular carcinomas: retrospective analysis of 120 cases. World J Surg 23:293–300. doi:10.1007/PL00013185

    Article  CAS  PubMed  Google Scholar 

  49. Ochiai T, Sonoyama T, Hironaka T et al (2003) Hepatectomy with chemoembolization for treatment of hepatocellular carcinoma. Hepatogastroenterology 50:750–755

    PubMed  Google Scholar 

  50. Chen XP, Hu DY, Zhang ZW et al (2007) Role of mesohepatectomy with or without transcatheter arterial chemoembolization for large centrally located hepatocellular carcinoma. Dig Surg 24:208–213

    Article  CAS  PubMed  Google Scholar 

  51. Choi GH, Kim DH, Kang CM et al (2007) Is preoperative transarterial chemoembolization needed for a resectable hepatocellular carcinoma? World J Surg 31:2370–2377. doi:10.1007/s00268-007-9245-6

    Article  PubMed  Google Scholar 

  52. Sasaki A, Iwashita Y, Shibata K et al (2006) Preoperative transcatheter arterial chemoembolization reduces long-term survival rate after hepatic resection for resectable hepatocellular carcinoma. Eur J Surg Oncol 32:773–779

    Article  CAS  PubMed  Google Scholar 

  53. Shi HY, Wang SN, Wang SC et al (2014) Preoperative transarterial chemoembolization and resection for hepatocellular carcinoma: a nationwide Taiwan database analysis of long-term outcome predictors. J Surg Oncol 109:487–493

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Funding

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jin Sub Choi.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lim, J.H., Choi, G.H., Choi, S.H. et al. Ventral Segment-Preserving Right Hepatectomy in Patients with Hepatocellular Carcinoma. World J Surg 39, 1034–1043 (2015). https://doi.org/10.1007/s00268-014-2894-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-014-2894-3

Keywords

  • Hepatic Vein
  • Bile Leakage
  • Liver Volume
  • Portal Vein Embolization
  • Middle Hepatic Vein