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Left hepatic trisegmentectomy with right hepatic vein resection after right hepatic vein embolization

2003; Elsevier BV; Volume: 133; Issue: 5 Linguagem: Inglês

10.1067/msy.2003.105

1532-7361

Masato Nagino, Tatsuharu Yamada, Junichi Kamiya, Katsuhiko Uesaka, Toshiyuki Arai, Yuji Nimura,

Vascular anomalies and interventions

Resection of the right hepatic vein (RHV) at its entry into the inferior vena cava (IVC) usually requires removal of the entire right posterior segment. However, the presence of a broad inferior right hepatic vein (IRHV) allows preservation of this segment. Nakamura and Tsuzuki 1 Nakamura S Tsuzuki T Surgical anatomy of the hepatic veins and the inferior vena cava. Surg Gynecol Obstet. 1981; 152: 43-50 PubMed Google Scholar found a broad IRHV was present in 20% to 24% of 83 autopsy specimens. Clinically, the IRHV can be visualized in approximately 10% of patients by abdominal ultrasonography. 2 Makuuchi M Hasegawa H Yamazaki S Bandai Y Watanabe G Ito T The inferior right hepatic vein: ultrasonic demonstration. Radiology. 1983; 148: 213-217 Crossref PubMed Scopus (99) Google Scholar In 1987, Makuuchi et al 3 Makuuchi M Hasegawa H Yamazaki S Takayasu K Four new hepatectomy procedures for resection of the right hepatic vein and preservation of the inferior right hepatic vein. Surg Gynecol Obstet. 1987; 164: 68-72 PubMed Google Scholar suggested the possibility of an IRHV-preserving left hepatic trisegmentectomy with combined resection of the RHV. This new hepatectomy was first performed by Baer et al 4 Baer HU Dennison AR Maddern GJ Blumgart LH Subtotal hepatectomy: a new procedure based on the inferior right hepatic vein. Br J Surg. 1991; 78: 1221-1222 Crossref PubMed Scopus (33) Google Scholar in 1991, and thereafter by Ozeki et al 5 Ozeki Y Uchiyama T Katayama M Sugiyama A Kokubo M Matsubara N Extended left hepatic trisegmentectomy with resection of main right hepatic vein and preservation of middle and inferior hepatic veins. Surgery. 1995; 117: 715-717 Abstract Full Text PDF PubMed Scopus (30) Google Scholar in 1995, for large hepatocellular carcinomas. These successful resections demonstrated that this type of hepatectomy is feasible when a stout IRHV is present. However, in the case of a large RHV and medium-sized IRHV, resection may be risky. This report describes the use of preoperative RHV embolization as preparation for this aggressive hepatectomy.