Hepatic segmentectomy combined with major hepatic vein resection for preserving remnant liver lobe

Impairment of liver function is the most serious complication that occurs after liver resection or in cirrhotic liver. Postoperative hepatic failure, which is mainly preceded by insufficient remnant liver function and/or postoperative septic complications, is the major cause of hospital mortality. This study was undertaken to evaluate hepatic segmentectomy combined with major hepatic vein (MHV) resection for preserving the remnant liver lobe in the treatment of resectable primary liver cancer.

From 1997 to 2007, six patients with primary liver cancer underwent hepatic segmentectomy with MHV resection, and three patients with hepatic vein injury had ligation of the MHV. The remnant liver lobe was preserved after hepatic segmentectomy combined with MHV resection or ligation.

The preserved liver lobe with normal structure could maintain hepatic function and showed no evidence of atrophy or swelling after hepatic segmentectomy combined with MHV resection or ligation.

After the right inferior hepatic vein is confirmed, and the MHV is occluded experimentally before hepatic segmentectomy combined with MHV resection, progressively deteriorating congestion does not occur in the preserved segment. Ligation or resection of the two MHVs must be avoided in patients with hepatic cirrhosis who have to undergo hepatic segmentectomy combined with MHV resection. Ligation of the MHV in patients with juxtahepatic vein injury is a simple and effective therapeutic modality.