Technique of right hemihepatectomy preserving ventral right anterior section guided by area of hepatic venous drainage

BackgroundAlthough the consequences of partial venous outflow interruption have attracted only limited attention in liver surgery, maximal preservation of liver function after hepatic resection requires preservation of circulation in the remnant liver, especially hepatic vein drainage.MethodsData from 30 patients undergoing 3-dimensional imaging were analyzed to clarify the relationship between the area of the ventral right anterior section (RAS) and that drained by regional hepatic vein tributaries. The feasibility of our preliminary technique of right hemihepatectomy preserving the ventral RAS also was evaluated.ResultsThe median estimated volume of the ventral RAS was 230 mL (range, 88–391). The average ratio of this estimated volume of the ventral RAS to total estimated liver volume was 18.0 ± 4.9%. The median volume of the territory served by middle hepatic vein (MHV) tributaries draining the ventral RAS, expressed as a percentage of the whole volume of the ventral RAS, was 82.5%. Findings in fusion images of portal and hepatic vein territories demonstrated an area of MHV tributaries comparable with the ventral RAS area in 73.3% of all cases. As for the results of right hemihepatectomy with the ventral RAS preserved, no tumor was exposed on transection surfaces, and no recurrence took place within the preserved ventral RAS of the remnant liver.ConclusionProcedures considering the importance of regional venous drainage offer the possibility of reducing the extent of surgery without loss of effectiveness.