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Anatomical Boundary Between the Caudate Lobe of the Liver and Adjacent Segments Based on Three-Dimensional Analysis for Precise Resections

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Right hemihepatectomy or systematic resection of segment 7 or 8 involves partial resection of the paracaval portion of the caudate lobe. However, the boundary between the caudate lobe and segment 7 or 8 remains unclear. We examined the anatomical territory of the caudate lobe with special reference to the boundary between the paracaval portion and segment 7 or 8 for precise anatomical hepatectomies.

Methods

We enrolled 63 consecutive healthy donor candidates for living-donor liver transplantation from 2012 to 2014 in this study. The caudate lobe was defined according to Kumon’s subdivision system, and the boundary between the paracaval portion and segment 7 or 8 was investigated based on three-dimensional computed tomography scan images using SYNAPSE VINCENT®.

Results

The paracaval portion of the liver protruded on the liver surface underneath the right diaphragm on the ventral side of the right hepatic vein (RHV) in 10 participants (16%) and on the dorsal side of the RHV in 9 participants (14%). A branch of the RHV, the “paracaval vein,” was found in all 63 participants and ran longitudinally along the right border of the paracaval portion (n = 30, 48%) and within segment 7 (n = 16, 25%) or segment 8 (n = 17, 27%).

Conclusions

The paracaval portion of the liver protruded on the liver surface underneath the right diaphragm in one third of our participants. The paracaval vein can be a landmark for the boundary between the caudate lobe and the segment 7 or 8 in half of the cases.

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Abbreviations

RHV:

Right hepatic vein

CT:

Computed tomography

DICOM:

Digital Imaging and Communications in Medicine

IVC:

Inferior vena cava

MHV:

Middle hepatic vein

P7:

Portal venous branch of segment 7

P8:

Portal venous branch of segment 8

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Authors and Affiliations

  1. Hepato-Biliary-Pancreatic Surgery Division, and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Harufumi Maki, Yoshihiro Sakamoto, Yoshikuni Kawaguchi, Nobuhisa Akamatsu, Junichi Kaneko, Junichi Arita, Kiyoshi Hasegawa & Norihiro Kokudo

Authors
  1. Harufumi Maki
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  2. Yoshihiro Sakamoto
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  3. Yoshikuni Kawaguchi
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  4. Nobuhisa Akamatsu
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  5. Junichi Kaneko
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  6. Junichi Arita
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  7. Kiyoshi Hasegawa
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  8. Norihiro Kokudo
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Contributions

HM, YS, and NK developed the concept and designed the study. HM and YS acquired, analyzed and interpreted the data. HM, YS, YK, NA, JK, JA, KH, and NK drafted and/or revised the manuscript. HM, YS, YK, NA, JK, JA, KH, and NK approved the final version of the manuscript.

Corresponding author

Correspondence to Yoshihiro Sakamoto.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Human/Animal Right

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed Consent

Informed consent was obtained from all participants to be included in the study.

Sources of Financial Support

There is no financial support on this study.

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Maki, H., Sakamoto, Y., Kawaguchi, Y. et al. Anatomical Boundary Between the Caudate Lobe of the Liver and Adjacent Segments Based on Three-Dimensional Analysis for Precise Resections. J Gastrointest Surg 22, 1709–1714 (2018). https://doi.org/10.1007/s11605-018-3819-5

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  • DOI: https://doi.org/10.1007/s11605-018-3819-5

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