Bisegmentectomie 7–8 : intérêt du repérage pré-opératoire d'une veine hépatique inférieure droite (VHID)

Hamy, A.; d'Alincourt, A; Floc’h, Isabelle; Madoz, A.; Paineau, J; Lerat, F

doi:10.1016/j.anchir.2004.02.007

Cited by 9 publications

(5 citation statements)

References 9 publications

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“…Это можно объяснить тем, что новообразования такой локализации в большинстве наблюдений вовлекают основной ствол ППВ и (или) формирующие его ветви. Резекция же ППВ теоретически сопряжена с риском нарушения адекватного венозного оттока от VI и латеральной части V сегмента печени с последующим развитием на этом фоне фиброза паренхимы с исходом в цирроз и последующую атрофию [13,14]. Риск развития описанных изменений возрастает также ввиду того, что подавляющее большинство больных оперируют на фоне ослабленной функции печени после многокурсовой химиотерапии и в результате персистирующего воспаления вследствие репликации одного из вирусов гепатита в гепатоцитах.…”

Section: Discussionunclassified

“…Риск развития описанных изменений возрастает также ввиду того, что подавляющее большинство больных оперируют на фоне ослабленной функции печени после многокурсовой химиотерапии и в результате персистирующего воспаления вследствие репликации одного из вирусов гепатита в гепатоцитах. Одной из мер, позволяющих не допустить развития этого осложнения, является восстановление венозного кровотока формированием вено-венозного анастомоза с помощью сосудистых протезов либо прямой имплантации ствола ППВ в полую вену [13,15,16]. Выделение интрапаренхиматозной части ППВ является сложной манипуляцией и в ряде ситуаций технически невыполнимо при вовлечении в опухолевый процесс формирующих ее ветвей.…”

Section: Discussionunclassified

“…Послеоперационной летальности не было. Медиана продолжительности пребывания в стационаре после операции составила 12 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) дней.…”

Section: результатыunclassified

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Resecting liver segments VII–VIII without reconstructing the right hepatic vein

et al. 2022

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Aim. To improve outcomes of treatment for neoplasms in segments VII-VIII of the liver adjacent to the main stem of the right hepatic vein and/or to its forming large branches.Materials and methods. In the period of 2016–2022, the resection of segments VII and/or VIII of the liver and the right hepatic vein, as well as its forming branches without reconstruction was performed in 24 patients. Surgical indications were liver metastases of colorectal cancer in 15 cases, hepatocellular cancer (cholangiocarcinoma) in six cases, angiomyolipoma in one case, uterine cancer metastases in one case and primary retroperitoneal tumor metastases in one case. Minor liver resections were additionally performed in 11 cases. Results. There were no intraoperative signs of impaired venous drainage. After surgery bile in the drains was detected in three patients, and a biliary fistula was formed in one case. No other complications were identified. No fatalities were registered after surgery. The late postoperative period revealed no specific complications related to a disturbance of venous drainage through the right hepatic vein.Conclusion. Existing and emerging collaterals can provide adequate venous drainage to the middle hepatic vein, short hepatic veins after resection of liver segments VII and VIII with resection of the right hepatic vein stem and its forming branches without reconstruction, even if the lower right hepatic vein is missing, and without complete obstruction of the right hepatic vein before surgery.

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Section: Discussionunclassified

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Resecting liver segments VII–VIII without reconstructing the right hepatic vein

et al. 2022

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“…Nakamura and Tsuzuki (25) advocated bisegmentectomy 7-8 only when there is a large RHV with small accessories veins. Others have shown that bisegmentectomy 7-8 is feasible and safe when there is a large right inferior hepatic vein (26)(27)(28). However, when a large right inferior hepatic vein is absent, controversies exist on the safety and feasibility of bisegmentectomy 7-8 (26,29).…”

Section: Discussionmentioning

confidence: 99%

“…Others have shown that bisegmentectomy 7-8 is feasible and safe when there is a large right inferior hepatic vein (26)(27)(28). However, when a large right inferior hepatic vein is absent, controversies exist on the safety and feasibility of bisegmentectomy 7-8 (26,29). In our study, only selected patients with right hepatic vein invasion by HCC with partial or complete venous blockage were chosen and this selection criterion is firstly reported.…”

Section: Discussionmentioning

confidence: 99%

Bisegmentectomy 7–8 for Small-for-Size Remanant Liver for Cirrhotic Patients Under Right Hemi-hepatectomy With Hepatocellular Carcinoma: A Case-Matched Comparative Study

et al. 2021

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Aim: To compare the short- and long-term treatment outcomes of bisegmentectomy 7–8 vs. right hepatectomy for patients with hepatocellular carcinoma and cirrhosis.Methods: Thirty six cirrhotic HCC patients with infiltration of right hepatic vein in segments 7–8 underwent bisegmentectomy 7–8 for small-for-size remanant liver under right hemi-hepatectomy. Its outcome was compared with a case-matched control group of cirrhotic HCC patients who underwent right hemi-hepatectomy during the study period.Results: The study group consisted of 36 patients and the control group 36 patients selected from 1,526 patients matched with age, tumor size, tumor location, and Pugh-Child staging. There were no significant differences between the two groups in operative parameters and in perioperative main complications which included hemorrhage, bile leakage, ascites, pleural effusion, and liver failure. The overall morbidity rate and morbidity rate classified according to Clavien's classification were similar. There was no in-hospital mortality or 90 day post-operative mortality. The mean follow-up was 30 and 32 months for the study group and control group, respectively. The disease free survival rate (DFS) for the study group was just significantly better than the control group. The median DFS was 24 months for the study group and 8 months for the control group (P = 0.049). Meanwhile, the median cumulative overall survival was 35 months for the study group and 27 months for the control group (P = 0.494).Conclusion: Bisegmentectomy 7–8 was safe and feasible for selected cirrhosis patients, and did not increase the perioperative risk and inferior long-term overall survival outcomes. It extended the indications for liver resection in patients with borderline volumes of future liver remnant for HCC cirrhotic liver.

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Feasibility of bisegmentectomy 7–8 is independent of the presence of a large inferior right hepatic vein

Machado

Herman

Makdissi

et al. 2006

Journal of Surgical Oncology

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Bisegmentectomy 7-8 may increase resectability rate in patients with bilateral lesions and may also enhance the opportunity to perform repeated resections in cases of tumor recurrence. Our study confirms the anatomical assumption that bisegmentectomy 7-8 did not result in segmental outflow block even in the absence of a thick inferior right hepatic vein and therefore should be performed more often than reported so far. The absence of this vein should not be a straightforward indication for right hepatectomy in cases where a liver-sparing procedure such as bisegmentectomy 7-8 can be safely employed.

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Bisegmentectomie 7–8 : intérêt du repérage pré-opératoire d'une veine hépatique inférieure droite (VHID)

Cited by 9 publications

References 9 publications

Resecting liver segments VII–VIII without reconstructing the right hepatic vein

Resecting liver segments VII–VIII without reconstructing the right hepatic vein

Bisegmentectomy 7–8 for Small-for-Size Remanant Liver for Cirrhotic Patients Under Right Hemi-hepatectomy With Hepatocellular Carcinoma: A Case-Matched Comparative Study

Feasibility of bisegmentectomy 7–8 is independent of the presence of a large inferior right hepatic vein

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