Background
Although the consequences of partial venous outflow interruption have attracted only
limited attention in liver surgery, maximal preservation of liver function after hepatic
resection requires preservation of circulation in the remnant liver, especially hepatic
vein drainage.
Methods
Data from 30 patients undergoing 3-dimensional imaging were analyzed to clarify the
relationship between the area of the ventral right anterior section (RAS) and that
drained by regional hepatic vein tributaries. The feasibility of our preliminary technique
of right hemihepatectomy preserving the ventral RAS also was evaluated.
Results
The median estimated volume of the ventral RAS was 230 mL (range, 88–391). The average
ratio of this estimated volume of the ventral RAS to total estimated liver volume
was 18.0 ± 4.9%. The median volume of the territory served by middle hepatic vein
(MHV) tributaries draining the ventral RAS, expressed as a percentage of the whole
volume of the ventral RAS, was 82.5%. Findings in fusion images of portal and hepatic
vein territories demonstrated an area of MHV tributaries comparable with the ventral
RAS area in 73.3% of all cases. As for the results of right hemihepatectomy with the
ventral RAS preserved, no tumor was exposed on transection surfaces, and no recurrence
took place within the preserved ventral RAS of the remnant liver.
Conclusion
Procedures considering the importance of regional venous drainage offer the possibility
of reducing the extent of surgery without loss of effectiveness.
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Article info
Publication history
Published online: July 13, 2009
Accepted:
April 10,
2009
Identification
Copyright
© 2010 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
