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Influence of the Glissonean Pedicle Transection Approach in Spiegel Lobe-Preserving Left Hepatectomy on Spiegel Lobe Volume and Remnant Liver Functions

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Abstract

Background

The extrahepatic surgical technique in liver resection can be divided into glissonean pedicle transection and glissonean separated transection approaches. In this study, we compared remnant liver function and liver regeneration involving the Spiegel lobe between these two approaches regarding Spiegel lobe-preserving left hepatectomy.

Methods

We enrolled 31 patients who underwent Spiegel lobe-preserving left hepatectomy for malignant hepatobiliary diseases between April 2008 and January 2020. The postoperative Spiegel lobe volume was measured using a volume analyzer at 3 and 6 months postoperatively.

Results

Of the 31 patients, 22 and 9 were included in the glissonean separated transection and glissonean pedicle transection groups, respectively. There was no significant between-group difference in the preoperative Spiegel lobe volume. However, the volumes at 3 and 6 months postoperatively were significantly larger in the glissonean pedicle transection group than in the glissonean transection group (29.92 mL vs. 13.00 mL; P < 0.001 and 28.43 mL vs. 15.01 mL; P < 0.001, respectively). There was no significant between-group difference in postoperative remnant liver function.

Conclusions

The postoperative Spiegel lobe volume was larger, and liver regeneration was better with the glissonean pedicle transection approach because of transection for Spiegel branch of the portal vein. It is desirable to preserve Spiegel branch in possible cases when surgeons select the glissonean separated transection approach based on the location and size of the tumors.

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Acknowledgements

We gratefully acknowledge the work of the past and present members of our division.

Funding

This study did not receive funding from any organization.

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Authors and Affiliations

  1. Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan

    Naoki Kamitani, Takeo Nomi, Daisuke Hokuto, Takahiro Yoshikawa, Yasuko Matsuo & Masayuki Sho

Authors
  1. Naoki Kamitani
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  2. Takeo Nomi
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  3. Daisuke Hokuto
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  4. Takahiro Yoshikawa
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  5. Yasuko Matsuo
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  6. Masayuki Sho
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Contributions

NK conducted the literature search and review, collected data, and drafted the manuscript. TN and DH proofread the manuscript. TY and YM discussed the significance of this manuscript. MS reviewed the manuscript and provided advice regarding the manuscript. All authors read and approved the final manuscript.

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Correspondence to Takeo Nomi.

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Kamitani, N., Nomi, T., Hokuto, D. et al. Influence of the Glissonean Pedicle Transection Approach in Spiegel Lobe-Preserving Left Hepatectomy on Spiegel Lobe Volume and Remnant Liver Functions. World J Surg 44, 3079–3085 (2020). https://doi.org/10.1007/s00268-020-05548-5

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  • DOI: https://doi.org/10.1007/s00268-020-05548-5

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