To establish a strategy for surgical resection of hepatic malignancies confined to segment VII.
Various 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.
WR 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).
WR, 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.
Even 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.
*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.
Reprints: Norihiro Kokudo, MD, PhD, Hepatobiliary Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail: KOKUDO-2SU@h.u-tokyo.ac.jp.
Disclosure: The authors declare no conflicts of interest. This work was supported by grants from the Takeda Science Foundation; the Kanae Foundation for the Promotion of Medical Science; the Ministry of Education, Culture, Sports, Science and Technology of Japan (No. 23689060); and the Ministry of Health, Labour and Welfare of Japan.