gms | German Medical Science

Introduction: Liver resection is the therapy of choice for the treatment of the liver tumors. The reasectabilty of single or multiple liver tumors depends on the localization of the tumors, quality of the liver, and the amount of the future liver remnant after resection. The ultimate goal of metastasis liver surgery is the oncological and liver parenchyma-sparing resection. A portion of patients might need a major liver resection or lose the surgical option due to the unfavorable location of tumors. Here we propose a new surgical strategy that may substantially improves the resectability of tumors.

Results: Since anatomical splitting of a liver can achieve a maximal exploration of tumor that located near the main vessels, an onkological resection without a major liver resection becomes possible. In a pilot (proof-of-principle) study, five patients with colorectal liver metastases located near the main liver vessels (one in bifucation of anterior and postperior branches of right portal vein, two in confluence of common hepatic duct one with segmental infiltration of middle hepatic vein). Two patients after right hemihepatectomy developed new metastasis that located in left predical portal vein, one in segment 2/3 and one in seg 2/3/4). All tumors were explored with in situ split of liver along the cantlie’s line or Lig. falciforme. A modified clamp and crash technique with or without hanging maneuver were applied for the parenchyma transsection. R0 resection of tumors could be achieved in all cases without a need of major liver resection. All patients recovered well and discharged shortly after the surgery.

Conclusion: In conclusions, in situ split liver resection represents a save and flexible method to 1) converse the respectability and 2) to achieve parenchyma-sparing resection.