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Annals of Surgical Oncology

, Volume 26, Issue 11, pp 3681–3681 | Cite as

Resection of the Dorsal Sector of the Liver: The Anterior Transhepatic Approach

  • Heithem Jeddou
  • Stylianos Tzedakis
  • Laurent Sulpice
  • Karim BoudjemaEmail author
Hepatobiliary Tumors
  • 140 Downloads

Abstract

Background

As defined by Couinaud et al. and Takasaki et al., the dorsal sector (DS) or caudate area is the portion of liver parenchyma located between the retrohepatic inferior vena cava (IVC) and the main hepatic veins confluence.1,2 Its complete resection, usually approached by right- or left-sided liver parenchymotomy, remains technically challenging.3,4 Moreover, these approaches usually fail to properly expose the middle (paracaval portion) and most cranial portion (i.e. behind the hepatic vein confluence) of the DS.5

Methods

We report the case of a 50-year-old woman presenting with a unique metachronous hepatic metastasis of a colorectal adenocarcinoma. The 40-mm lesion was located behind the confluence of the three main hepatic veins, in front of the IVC, and extended caudally behind the hepatic hilum, thereby occupying the paracaval portion of the DS. The tumor board decision was surgical resection.

Results

The procedure included complete anatomic resection of the DS using an anterior transhepatic approach by opening the liver midplane along the Cantlie line. A well-tolerated continuous pedicle and IVC clamping of 30 min was used. The duration of the surgery was 120 min, and the blood loss was 200 mL. The patient was discharged on postoperative day 5. R0 resection was achieved and the patient was free of disease at 1 year post-surgery.

Conclusion

Anatomic resection of the DS using a transparenchymal anterior approach is a safe and feasible procedure especially suitable for voluminous tumors. It allows the control of all major vascular structures narrowing the lesion, and facilitates an R0 resection.

Notes

Supplementary material

Supplementary material 1 (MP4 781414 kb)

References

  1. 1.
    Couinaud C. Surgical anatomy of the liver. Several new aspects. Chirurgie. 1986;112(5):337–42. [in French].PubMedGoogle Scholar
  2. 2.
    Takasaki K. Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation. J Hepatobiliary Pancreat Surg. 1998;5(3):286–91.CrossRefPubMedGoogle Scholar
  3. 3.
    Chaib E, Ribeiro MA Jr, Silva Fde S, et al. Caudate lobectomy: tumor location, topographic classification, and technique using right- and left-sided approaches to the liver. Am J Surg. 2008;196(2):245–51.CrossRefPubMedGoogle Scholar
  4. 4.
    Wang Y, Zhang LY, Yuan L, et al. Isolated caudate lobe resection for hepatic tumor: surgical approaches and perioperative outcomes. Am J Surg. 2010;200(3):346–51.CrossRefPubMedGoogle Scholar
  5. 5.
    Kumon M. Anatomical study of the caudate lobe with special reference to portal venous and biliary branches using corrosion liver casts and clinical application. Liver Cancer. 2017;6(2):161–70.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Heithem Jeddou
    • 1
  • Stylianos Tzedakis
    • 1
  • Laurent Sulpice
    • 1
  • Karim Boudjema
    • 1
    Email author
  1. 1.Department of Hepatobiliary and Digestive SurgeryPontchaillou University HospitalRennesFrance

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