Anatomical bi- and trisegmentectomies as alternatives to extensive liver resections |
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| Authors: | Chouillard Elie Cherqui Daniel Tayar Claude Brunetti Francesco Fagniez Pierre-Louis |
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| Affiliation: | Department of Digestive Surgery, H?pital Henri Mondor-Université Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France. |
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| Abstract: | OBJECTIVE: To assess the technical and oncologic results of anatomic hepatic bi- and trisegmentectomies. SUMMARY BACKGROUND DATA: Regardless of their size, some tumors require extensive hepatectomy only because they are located centrally or in the vicinity of major portal pedicles or hepatic veins. Anatomic bi- and trisegmentectomy might represent an alternative to extensive hepatectomies in such cases. METHODS: Of 435 liver resections, 32 cases (7%) included 2 or 3 adjacent segments (left lateral sectionectomies, ie, bisegmentectomies 2-3, excluded). There were 16 central hepatectomies (segments 4, 5, and 8), 7 right posterior sectionectomies (segments 6 and 7) and 2 central anterior (segments 4b and 5), 1 central posterior (segments 4a and 8), 2 right superior (segments 7 and 8), 3 right inferior (segments 5 and 6), and 1 left anterior (segments 3 and 4b) bisegmentectomies. Indications were malignant disease in 29 patients, including 15 with cirrhosis and 2 with benign tumors. External landmarks, selective devascularization, and intraoperative ultrasound were used to achieve anatomic resection. RESULTS: Mortality, transfusion, and morbidity rates were 0%, 26%, and 19%, respectively. Mean section margin was 9 mm (range, 1-40 mm). Isolated intrahepatic recurrence occurred in 7 patients (24%) and 3 (43%) underwent repeat hepatectomy. CONCLUSION: Anatomic bi- or trisegmentectomy is a safe alternative to extensive liver resection in selected patients, avoiding unnecessary sacrifice of functional parenchyma and enhancing the opportunity to perform repeat resections in cases of recurrence. |
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