Article
Parenchymal sparring in respect to venous outflow in patients undergoing extended left hepatectomy – a MeVis Study
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Published: | March 21, 2014 |
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Introduction: In patients with small remnant liver, modified extended left hepatectomy (ELH) with preserving partial segment 8 and total segment 5 might avoid post-hepatectomy liver failure (PHLF) if a sufficient outflow could be ensured. The aim of the study is to find out whether preserving of segment 5 could avoid PHLF according to the clinical course as well as volumetric analysis by MeVis.
Material and methods: Modified ELH was defined as resection of segment 2, 3, 4 and most of the segment 8, with or without segment 1. The segment 5 was kept in the remnant liver with at least 1 cm margin to the tumor. A liver volume analysis using 3D reconstruction byMeVis was carried out. Data, including transfusion, ICU stay, R0 status, postoperative complications, especially PHLF or bile leak, were analyzed.
Results: Modified ELH with preserving segment 5 can be carried out in five of seven patients who were otherwise indicated for a left trisectionectomy for patients with intrahepatic malignancy from April 2012. In the other two patients tumor involvement of segment 5 and 8 made left trisectionectomy mandatory. MeVis analysis showed that preserving segment 5 led to increasing remnant liver volume 26% to 67%. Remnant liver was drained by the right hepatic vein (RHV) alone in four patients, by the RHV and the middle hepatic vein (MHV) in two patients. R0 status was confirmed in all five patients. No posthepatectomy liver failure developed. One patient had Grad IIIb bile leak which was successfully managed by reoperation. No complication was developed in others.
Conclusion: Parenchyma-sparring in ELH is feasible and worthwhile. With respect to the venous outflow, segment 5 can be preserved in most of the case when no tumor involvement was found.