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Ventral Segment-Preserving Right Hepatectomy in Patients with Hepatocellular Carcinoma

 Jin Hong Lim  ;  Gi Hong Choi  ;  Sung Hoon Choi  ;  Hyung Soon Lee  ;  Kyung Sik Kim  ;  Jin Sub Choi 
 World Journal of Surgery, Vol.39(4) : 1034-1043, 2015 
Journal Title
 World Journal of Surgery 
Issue Date
Adult ; Aged ; Carcinoma, Hepatocellular/surgery* ; Disease-Free Survival ; Female ; Hepatectomy/adverse effects ; Hepatectomy/methods* ; Humans ; Liver/pathology* ; Liver/physiopathology ; Liver/surgery ; Liver Neoplasms/surgery* ; Male ; Middle Aged ; Neoplasm Recurrence, Local* ; Organ Size ; Organ Sparing Treatments* ; Retrospective Studies ; Serum Albumin/metabolism ; Survival Rate
BACKGROUND: Transection along the anterior fissure was proposed as a mechanism by which to open the third door of the liver. In this study, we investigated surgical outcomes of a ventral segment-preserving right hepatectomy (VSPRH) compared with those of conventional right hepatectomy in patients with hepatocellular carcinoma (HCC). METHODS: Between January 2007 and December 2010, 595 primary HCC patients underwent liver resection at the authors' institution. Among them, the 123 HCC patients who underwent a right hepatectomy were retrospectively analyzed. The patients were classified into two groups according to the type of resection: those who underwent a VSPRH (Group A; 27 cases) and those who underwent a conventional right hepatectomy (Group B; 96 cases). RESULTS: In Group A, expected remnant liver volume after a right hepatectomy was calculated to be 32.1 ± 7.2% of functional total liver volume (FTLV); remnant liver volume increased up to 54.7 ± 7.2% of FTLV after a VSPRH. Clinicopathologic characteristics and intraoperative data did not differ between the two groups. The liver-related complication rate was higher in Group B (P = 0.02). Overall survival and disease-free survival rates were similar (3-year disease-free survival (Group A: 67.8%; Group B: 71.7%; P = 0.65); 3-year overall survival (Group A: 91.7%; Group B: 87.4%; P = 0.26). In regard to long-term synthetic function, the 1-year postoperative serum albumin level was higher in Group A. CONCLUSIONS: A VSPRH yielded fewer liver-related complications and similar long-term oncologic outcomes, compared with conventional right hepatectomy in cirrhotic patients with a small left lobe volume. Therefore, VSPRH can be considered to be an alternative procedure for a right hepatectomy.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
김경식(Kim, Kyung Sik) ORCID logo https://orcid.org/0000-0001-9498-284X
임진홍(Lim, Jin Hong)
최기홍(Choi, Gi Hong) ORCID logo https://orcid.org/0000-0002-1593-3773
최진섭(Choi, Jin Sub)
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