Ann Hepatobiliary Pancreat Surg.  2024 Feb;28(1):25-33. 10.14701/ahbps.23-076.

Parenchymal-sparing anatomical hepatectomy based on portal ramification of the right anterior section: A prospective multicenter experience with short-term outcomes

• Nguyen TG
• Nguyen TK
• Nguyen HH
• Trinh HS
• Luong TH
• Nguyen MT
• Le VD
• Do HD
• Nguyen KH
• Do VM
• Tran QH
• Nguyen CT

• KMID: 2553362
• DOI: http://doi.org/10.14701/ahbps.23-076

Abstract

Backgrounds/Aims
Parenchymal-sparing anatomical hepatectomy (Ps–AH) based on portal ramification of the right anterior section (RAS) is a new technique to avoid unnecessarily transecting too much liver parenchyma, especially in cases of major anatomical hepatectomy.
Methods
We prospectively assessed 26 patients with primary hepatic malignancies having undergone major Ps–AH based on portal ramification of the RAS from August 2018 to August 2022 (48 months). The perioperative indications, clinical data, intra-operative index, pathological postoperative specimens, postoperative complications, and follow-up results were retrospectively evaluated.
Results
Among the 26 patients analyzed, there was just one case that had intrahepatic cholangiocarcinoma The preoperative level of α– Fetoprotein was 25.2 ng/mL. All cases (100%) had Child–Pugh A liver function preoperatively. The ventral/dorsal RAS was preserved in 19 and 7 patients, respectively. The mean surgical margin was 6.2 mm. The mean surgical time was 228.5 minutes, while the mean blood loss was 255 mL. In pathology, 5 cases (19.2%) had microvascular invasion, and in the group of HCC patients, 92% of all cases had moderate or poor tumor differentiation. Six cases (23.1%) of postoperative complications were graded over III according to the Clavien–Dindo system, including in three patients resistant ascites or intra-abdominal abscess that required intervention.
Conclusions
Parenchymal-sparing anatomical hepatectomy based on portal ramification of the RAS to achieve R0-resection was safe and effective, with favorable short-term outcomes. This technique can be used widely in clinical practice.

Keyword

Anatomical hepatectomy; Portal ramification; Right anterior section; Ventral–dorsal segmentation

Figure

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  Fig. 1 Schema of ventral segment sparing right hepatectomy (resection of hepatic segments 6, 7, d5, and d8). (A) Preoperative. (B) Postoperative.

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  Fig. 2 Ventral segment sparing right hepatectomy (resection of hepatic segments 6, 7, d5, and d8).

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  Fig. 3 Schema of dorsal segment sparing mesohepatectomy (resection of hepatic segments 4, v5, and v8 ± 1). (A) Preoperative. (B) Postoperative.

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  Fig. 4 Dorsal segment sparing mesohepatectomy (resection of hepatic segments 4, v5, and v8 ± 1).

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  Fig. 5 Schema of dorsal segment preserving left trisectionectomy (resection of hepatic segments 2, 3, 4, v5, and v8). (A) Preoperative. (B) Postoperative.

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  Fig. 6 Dorsal segment preserving left trisectionectomy (resection of hepatic segments 2, 3, 4, v5, and v8).

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  Fig. 7 Dorsal segment preserving left trisectionectomy and caudate lobectomy (resection of hepatic segments 1, 2, 3, 4, v5, and v8).

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  Fig. 8 Segment 8 sparing right hepatectomy with or without caudate lobectomy (resection of hepatic segments 5, 6, and 7 ± 1).

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