Extended central hepatectomy with preservation of segment 6 for patients with centrally located hepatocellular carcinoma

摘要

BACKGROUND: In  order  to  preserve  functional  liver  paren-chyma, extended central hepatectomy (segments 4, 5, 7 and 8 resection) was proposed for the management of centrally lo-cated hepatocellular carcinoma invading the right and middle hepatic veins, reconstructing segment 6 outflow in the absence of the thick inferior right hepatic vein. The present study was to describe our surgical techniques of extended central hepa-tectomy. METHODS: Between 2008 and 2012, 5 patients with centrally located hepatocellular carcinoma invading or in the vicinity of  the  right  and  middle  hepatic  veins  underwent  extended central hepatectomy. The thick inferior right hepatic vein was preserved during dissection. Gore-Tex graft was used for seg-ment 6 outflow reconstruction in the absence of the thick infe-rior right hepatic vein. RESULTS: The  mean  future  remnant  liver  volume  for  seg-ments 2 and 3 was 28% versus 45% on segment 6 preservation. The mean tumor diameter was 7.4 cm. The thick inferior right hepatic vein was found in 1 patient. Outflow reconstruction from  segment  6  was  performed  in  4  patients.  Postoperative complications  included  bile  leakage  (1  patient),  pleural  effu-sion (2) and liver failure (1). The rate of graft patency was 75%. There was no perioperative mortality. CONCLUSION: Extended central hepatectomy is a safe alter-native  for  extended  hepatic  resection  in  selected  patients  at-tempting to preserve the functional liver parenchyma.