Extreme liver resections with preservation of segment 4 only

作     者：Silvio Marcio Pegoraro Balzan Vinícius Grando Gava Marcelo Arbo Magalhaes Marcelo Luiz Dotto 

作者机构：Department of Pharmacy and BiologyUniversity of Santa Cruz do Sul Department of SurgeryHospital Moinhos de Vento 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2017年第23卷第26期

页      面：4815-4822页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Hepatectomy Colorectal liver metastases Hepatic congestion Liver regeneration Liver resection Liver failure 

摘      要：To evaluate safety and outcomes of a new technique for extreme hepatic resections with preservation of segment 4 only. METHODSThe new method of extreme liver resection consists of a two-stage hepatectomy. The first stage involves a right hepatectomy with middle hepatic vein preservation and induction of left lobe congestion; the second stage involves a left lobectomy. Thus, the remnant liver is represented by the segment 4 only (with or without segment 1, ± S1). Five patients underwent the new two-stage hepatectomy (congestion group). Data from volumetric assessment made before the second stage was compared with that of 10 matched patients (comparison group) that underwent a single-stage right hepatectomy with middle hepatic vein preservation. RESULTSThe two stages of the procedure were successfully carried out on all 5 patients. For the congestion group, the overall volume of the left hemiliver had increased 103% (mean increase from 438 mL to 890 mL) at 4 wk after the first stage of the procedure. Hypertrophy of the future liver remnant (i.e., segment 4 ± S1) was higher than that of segments 2 and 3 (144% vs 54%, respectively, P 0.05) were proportional. The mean preoperative volume of segments 2 and 3 was 256 ± 64 cc and increased to 572 ± 257 cc after right hepatectomy. Mean preoperative volume of segment 4 increased from 211 ± 75 cc to 439 ± 180 cc after surgery. CONCLUSIONThe proposed method for extreme hepatectomy with preservation of segment 4 only represents a technique that could allow complete resection of multiple bilateral liver metastases.