Abstract
Background
The portal vascularization of segment IV (S4) of the liver has not been well described. Knowledge of the portal supply to S4 is of great interest for liver surgery and for interventional radiological procedures. This study aimed to analyse the distribution of portal vein branches supplying S4.
Methods
We retrospectively analysed data from patients operated on for liver tumours between 2007 and 2016. Patients with involvement of S4 branches or the left portal vein, previous liver surgery or poor quality imaging were excluded. Branches originating from the right portal vein and/or from the transverse part of the left portal vein (TPLPV) and/or from the umbilical part of the portal vein (UPLPV) were identified.
Results
In 102 patients who underwent a right hepatectomy, S4 was vascularized by 2–8 branches of the left portal vein, with 84.3 % of patients having 3–6 branches. Only eleven patients (10.8 %) had portal branches originating from the TPLPV, with no impact on the number of branches coming from the UPLPV. Three patients (2.9 %) had one branch from the right portal vein. In patients with only two or three branches supplying S4, the branches had a larger diameter and typically arose from a short common trunk which divided further within its first centimetres.
Conclusions
Portal vascularization of S4 varies widely (2–8 branches) between patients and originates predominantly from the junction between the left portal vein and the round ligament. There is no anatomical rationale to divide S4 into S4a and S4b.
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References
Bismuth H (2013) Revisiting liver anatomy and terminology of hepatectomies. Ann Surg 257(3):383–386
Capussotti L, Muratore A, Ferrero A, Anselmetti GC, Corgnier A, Regge D (2005) Extension of right portal vein embolization to segment IV portal branches. Arch Surg 140(11):1100–1103
Dupre A, Hitier M, Peyrat P, Chen Y, Meeus P, Rivoire M (2015) Associating portal embolization and artery ligation to induce rapid liver regeneration in staged hepatectomy. Br J Surg 102(12):1541–1550
El Gharbawy RM, Nour BM (2013) Segment 4 architecture and proposed parenchyma-wise technique for ex vivo graft procurement and implantation. Liver Transpl 19(11):1189–1201
Guiney MJ, Kruskal JB, Sosna J, Hanto DW, Goldberg SN, Raptopoulos V (2003) Multi-detector row CT of relevant vascular anatomy of the surgical plane in split-liver transplantation. Radiology 229(2):401–407
Kawarada Y, Das BC, Onishi H, Taoka H, Gadzijev EM, Ravnik D, Tabata M, Isaji S (2000) Surgical anatomy of the bile duct branches of the medial segment (B4) of the liver in relation to hilar carcinoma. J Hepatobiliary Pancreat Surg 7(5):480–485
Kim YK, Han HS, Yoon YS, Cho JY, Lee W (2015) Total anatomical laparoscopic liver resection of segment 4 (S4), extended S4, and subsegments S4a and S4b for hepatocellular carcinoma. J Laparoendosc Adv Surg Tech A 25(5):375–379
Onishi H, Kawarada Y, Das BC, Nakano K, Gadzijev EM, Ravnik D, Isaji S (2000) Surgical anatomy of the medial segment (S4) of the liver with special reference to bile ducts and vessels. Hepatogastroenterology 47(31):143–150
Petrowsky H, Gyori G, de Oliveira M, Lesurtel M, Clavien PA (2015) Is partial-ALPPS safer than ALPPS? A single-center experience. Ann Surg 261(4):e90–e92
Sales JP, Hannoun L, Sichez JP, Honiger J, Levy E (1984) Surgical anatomy of liver segment IV. Anat Clin 6(4):295–304
Schnitzbauer AA, Lang SA, Goessmann H, Nadalin S, Baumgart J, Farkas SA, Fichtner-Feigl S, Lorf T, Goralcyk A, Horbelt R, Kroemer A, Loss M, Rummele P, Scherer MN, Padberg W, Konigsrainer A, Lang H, Obed A, Schlitt HJ (2012) Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 255(3):405–414
Shindoh J, Vauthey JN, Zimmitti G, Curley SA, Huang SY, Mahvash A, Gupta S, Wallace MJ, Aloia TA (2013) Analysis of the efficacy of portal vein embolization for patients with extensive liver malignancy and very low future liver remnant volume, including a comparison with the associating liver partition with portal vein ligation for staged hepatectomy approach. J Am Coll Surg 217(1):126–133 (discussion 133–124)
Xie YZ, Liu J, Chung GH, Kong X, Li XJ, Zhang LT, Ma ZB, Chai OH, Kim HT, Song CH (2014) Visualization of the segment IV hepatic artery using 128-section MDCT angiography. Clin Radiol 69(9):965–973
Yan PN, Tan WF, Yang XW, Zhang CS, Jiang XQ (2014) Applied anatomy of small branches of the portal vein in transverse groove of hepatic hilum. Surg Radiol Anat 36(10):1071–1077
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Rob Stepney (Charlbury, UK) assisted in editing the manuscript.
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Maurer, R., Rivoire, M., Basso, V. et al. Portal supply of segment IV of the liver based on CT-scan. Surg Radiol Anat 39, 471–476 (2017). https://doi.org/10.1007/s00276-016-1761-3
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DOI: https://doi.org/10.1007/s00276-016-1761-3