Extreme liver resections with preservation of segment 4 only
| Autor: | Marcelo Luiz Dotto, Vinicius Grando Gava, Marcelo Arbo Magalhães, Silvio Marcio Pegoraro Balzan |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Observational Study 030230 surgery Liver resections Hepatic congestion Complete resection Muscle hypertrophy Remnant liver 03 medical and health sciences 0302 clinical medicine medicine Hepatectomy Humans Stage (cooking) Vein Aged Retrospective Studies Liver resection business.industry Liver Neoplasms Liver failure Gastroenterology Hypertrophy General Medicine Middle Aged Liver regeneration Liver Regeneration Surgery Colorectal liver metastases medicine.anatomical_structure 030220 oncology & carcinogenesis Female Colorectal Neoplasms business |
| Zdroj: | World Journal of Gastroenterology |
| ISSN: | 1007-9327 |
| DOI: | 10.3748/wjg.v23.i26.4815 |
| Popis: | AIM To evaluate safety and outcomes of a new technique for extreme hepatic resections with preservation of segment 4 only. METHODS The 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. RESULTS The 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). The median remnant liver volume-to-body weight ratio was 0.3 (range, 0.28-0.40) before the first stage and 0.8 (range, 0.45-0.97) before the second stage. For the comparison group, the rate of hypertrophy of the left liver after right hepatectomy with middle hepatic vein preservation was 116% ± 34%. Hypertrophy rates of segments 2 and 3 (123% ± 47%) and of segment 4 (108% ± 60%, 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. CONCLUSION The proposed method for extreme hepatectomy with preservation of segment 4 only represents a technique that could allow complete resection of multiple bilateral liver metastases. |
| Databáze: | OpenAIRE |
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