• Annals of surgery · Mar 2016

    Surgical Indications and Procedures for Resection of Hepatic Malignancies Confined to Segment VII.

    • Chetana Lim, Takeaki Ishizawa, Akinori Miyata, Yoshihiro Mise, Yoshihiro Sakamoto, Kiyoshi Hasegawa, Yasuhiko Sugawara, and Norihiro Kokudo.
    • *Hepatobiliary Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan †Department of Hepatobiliary Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Creteil, France.
    • Ann. Surg. 2016 Mar 1; 263 (3): 529-37.

    ObjectiveTo establish a strategy for surgical resection of hepatic malignancies confined to segment VII.BackgroundVarious surgical procedures can be used to resect hepatic malignancies in segment VII, the deepest region of the liver, by open and/or laparoscopic approaches: nonanatomic wedge resection (WR), segmentectomy VII, right lateral sectionectomy (RLS), and right hepatectomy.MethodsWR and segmentectomy VII were applied as first-line surgical procedures for colorectal liver metastasis (CRLM) and hepatocellular carcinoma (HCC), respectively. RLS and right hepatectomy were indicated only when tumor infiltration to the proximal Glissonian sheath was suspected. Operative outcomes were evaluated in 200 consecutive patients who underwent hepatic resection for HCC (n = 120) or CRLM (n = 80).ResultsWR, segmentectomy VII, RLS, and right hepatectomy were performed in 104 (52.0%), 57 (28.5%), 22 (11.0%), and 17 (8.5%) patients, respectively. Local hepatectomy (WR and segmentectomy VII) led to shorter operation times and lower blood loss volumes than did extensive hepatectomy (RLS and right hepatectomy). Thoracotomy was performed in half of the WR and two-thirds of the segmentectomy VII procedures. The availability of a laparoscopic approach was 40% (8 patients) after its application in October 2012.ConclusionsEven for hepatic malignancies located in segment VII, WR and segmentectomy should be prioritized over extensive hepatectomy to preserve the postoperative functional hepatic volume. Full mobilization of the right liver and a good surgical field provided by a large thoracoabdominal or abdominal incision or a laparoscopic approach are key factors for safe performance of deep hepatic transection.

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