Personal experience of right anterior segmentectomy (segments V and VIII) for hepatic malignancies

Right anterior segmentectomy is the most difficult type of hepatic resection to perform and is reported only rarely. For patients with tumors limited to the anterior segment but complicated by mild liver dysfunction, this is the only type of hepatectomy that can be tolerated. This article described personal experience with this operation in 17 patients with liver malignancies.

Fourteen patients had hepatocellular carcinoma, one had cholangiocellular carcinoma, and two had metastases, one from rectal and the other from gastric carcinoma. Except in one case of dense adhesion of the hepatoduodenal ligament, hemihepatic vascular occlusion was used. Both the right and middle hepatic veins were fully exposed in 14 patients.

The average operation time was 412 minutes and the average blood loss was 1482 ml. There was one operative death as a result of pneumonia and liver failure. Another patient had prolonged bile leakage with right pleural effusion and bleeding gastric erosions. The cumulative 1- and 5-year survival rates were 88% and 47%, respectively.

The results of this experience indicate that in selected patients with hepatic malignancies this procedure is safe and compatible with improved survival. This may be the first report to describe the clinical features and operative technique in a series of patients treated by right anterior segmentectomy.