Extrahepatic division of the right hepatic vein in hepatectomy

Extrahepatic division of the right hepatic vein, after division of the inferior vena cava ligament and, if necessary, of the adrenal gland, was performed during 87 liver resections, and the results compared with those of intraparenchymal division of the right hepatic vein in 32 similar hepatectomies. The selection of the method reflected the surgeon's preference, and was unrelated to the weight of the resected specimen. The incidences of injury to the adrenal gland, inferior vena cava and short hepatic veins were comparable with the two methods, 28 versus 26%, but massive bleeding occurred in 13 vs. 6%, and the mean operative bleeding was 3.8 vs. 1.8 liters (p less than 0.01) during intrahepatic and extrahepatic dissection, respectively. Tumors close to the junction of the right hepatic vein with the inferior vena cava cannot be removed radically with intraparenchymal division of the right hepatic vein. For these reasons, we prefer extrahepatic right hepatic vein division, which was technically possible in 75 of the 84 cases in whom it was attempted.