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The proximity of the middle hepatic vein to the hepatic hilus: a retrospective radiological study

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Abstract

Purpose

The middle hepatic vein (MHV) is an important landmark in anatomical hemihepatectomy. The proximity between the MHV and the hilar plate was suspected to be associated with tumor exposure during left hemihepatectomy for advanced perihilar cholangiocarcinoma and is reported to facilitate a dorsal approach to the MHV during laparoscopic hemihepatectomy. However, the precise distance between these locations is unknown.

Methods

To investigate the “accurate and normal” distance between the MHV and the hilar plate, the present study focused on patients who presented without perihilar tumor. One hundred and sixty-eight consecutive patients who underwent pancreatoduodenectomy were included. Retrospective radiological measurement was performed using preoperative multi-detector row CT. The optimized CT slices perpendicular to the MHV were made using the multiplanar reconstruction technique. The shortest distance between the MHV and the hilar plate was measured on the left and right sides on the perpendicular slices. The diameters of the left and right hepatic ducts were also measured.

Results

The distance was 9.0 mm (1.9–20.0 mm) on the left side and 11.3 mm (2.3–21.8) on the right side (p < 0.001). The distance on the left side was < 10 mm in 60% of patients (n = 100). Only one-third of patients (n = 55) had a distance of ≥ 10 mm on both sides. As the hepatic ducts became more dilated, the distance from the MHV to the hilar plate became shorter.

Conclusion

The MHV was located in close proximity to the hepatic hilus, especially on the left side.

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Availability of data and materials

The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

There were no grants or other financial support for this study.

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Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunoto-Nagaizumi, Shizuoka, 411-8777, Japan

    Shimpei Otsuka, Teiichi Sugiura, Yukiyasu Okamura, Ryo Ashida, Katsuhisa Ohgi, Mihoko Yamada & Katsuhiko Uesaka

  2. Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan

    Takeshi Aramaki

Authors
  1. Shimpei Otsuka
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  2. Teiichi Sugiura
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  3. Yukiyasu Okamura
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  4. Ryo Ashida
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  5. Katsuhisa Ohgi
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  6. Mihoko Yamada
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  7. Takeshi Aramaki
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  8. Katsuhiko Uesaka
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Contributions

Study conception and design: SO, TS. Acquisition of data: SO, TA. Analysis and interpretation of data: SO, TS. Drafting of manuscript: SO. Critical revision: all authors.

Corresponding author

Correspondence to Shimpei Otsuka.

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Conflict of interest

All authors declare no conflicts of interest in association with the present study.

Ethical approval

This study was approved by the Human Research Review Committee of Shizuoka Cancer Center (approval number 2019-0184).

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Supplementary Information

Below is the link to the electronic supplementary material.

276_2022_3050_MOESM1_ESM.tif

Supplementary file1 Schmea of the angle of the perpendicular slice (right anterior oblique 61.5° and caudal 34.8°, [median]) (TIF 565 KB)

Supplementary file2 Examples of anatomical types (TIF 3428 KB)

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Otsuka, S., Sugiura, T., Okamura, Y. et al. The proximity of the middle hepatic vein to the hepatic hilus: a retrospective radiological study. Surg Radiol Anat 45, 65–71 (2023). https://doi.org/10.1007/s00276-022-03050-2

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  • DOI: https://doi.org/10.1007/s00276-022-03050-2

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