Comparison of Regeneration of Remnant Liver After Hemihepatectomy with or Without the Middle Hepatic Vein

Inoué, Yoshihiro; Suzuki, Yusuke; Ota, Masato; Fujii, Kensuke; Kawaguchi, Nao; Shimizu, Tetsunosuke; Asakuma, Mitsuhiro; Hirokawa, Fumitoshi; Hayashi, Michihiro; Uchiyama, Kazuhisa

doi:10.1007/s00268-017-4225-y

Cited by 10 publications

(10 citation statements)

References 36 publications

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“…RLV was measured using multidetector computed tomography at postoperative day 7 and months 1, 2, and 5. We calculated the following values: (a) the RLV at day 0 after surgery, calculated as (TLV + tumor volume) -resected liver volume, and (b) the regeneration rate, calculated as (RLV at day 7 and at 1, 2, and 5 months/TLV) × 100 [13].…”

Section: Liver Volume Measurementsmentioning

confidence: 99%

The Management of Recurrence within Six Months after Hepatic Resection for Colorectal Liver Metastasis

et al. 2019

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Background: Hepatectomy is currently recommended as the most reliable treatment for colorectal liver metastases. However, the association between the choice of treatment for recurrence and the timing of recurrence remains controversial. Methods: Two-hundred ninety-five patients who underwent hepatectomy were retrospectively analyzed for the risk factors and the outcomes for early recurrence within 6 months. The remnant liver volumes (RLVs) and laboratory data were measured postoperatively using multidetector computed tomography on days 7 and months 1, 2, and 5 after the operation. Results: Early recurrence developed in 88/295 patients (29.8%). Colorectal cancer lymph node metastasis, synchronous liver metastasis, and multiple liver metastases were independent risk factors for the occurrence of early recurrence (p < 0.001, 0.032, and 0.019, respectively). Patients with early recurrence had a poorer prognosis than did patients who developed later recurrence (p < 0.001). Patients who underwent surgery or other local treatment had better outcomes. The changes in RLV and laboratory data after postoperative month 2 were not significantly different between the 2 groups. Conclusion: Patients with early recurrence within 6 months had a poorer prognosis than did patients who developed later recurrence. However, patients who underwent repeat hepatectomy for recurrence had a better prognosis than did those who underwent other treatments, with good prospects for long-term survival.

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Section: Liver Volume Measurementsmentioning

confidence: 99%

The Management of Recurrence within Six Months after Hepatic Resection for Colorectal Liver Metastasis

et al. 2019

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“…Hemihepatectomy guided by MHV has the potential to achieve an adequate tumor-free resection margin while preserving venous drainage and functional liver tissues, which may result in a higher tumor-free survival rate [10]. Therefore, the MHV should be preserved or reconstructed whenever possible during hepatic hemihepatectomy [11]. In the present case, the patient presented with liver cirrhosis.…”

Section: Discussionmentioning

confidence: 77%

Right Hemihepatectomy via an Anterior Approach for Hepatocellular Carcinoma in a Situs Inversus Totalis Patient

Zhang

et al. 2020

Case Rep Gastroenterol

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Situs inversus totalis (SIT) is a rare congenital condition in which the usual position of the organs is reversed from left to right as a mirror image of the normal situation. Due to the abnormal transposition, this represents a technical challenge for the surgeon. In the present study, right hemihepatectomy via the anterior approach was performed for a 68-year-old hepatocellular carcinoma (HCC) patient with SIT. SIT was diagnosed by chest X-ray and computed tomography. The tumors were located in segments VIII and VI of the liver, and there was no metastasis to the lymph nodes and distant organs. Hemihepatic vascular inflow occlusion was performed using the selective intra-Glissonian approach. The middle hepatic vein was preserved under the guidance with intraoperative ultrasonography. The present case suggests that right hemihepatectomy via the anterior approach may be a safe, feasible, and effective procedure for HCC patients with SIT.

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“…Such an increased portal flow contributes to endothelial damage, resulting in small for flow syndrome. Inoue et al [3] assessed the relationship between resection of MHV and liver regeneration by performing CT scans on day 7 as well as at 1, 2, 5, and 12 months after resection and reported that the regeneration rate is significantly higher when the MHV is preserved in cases undergoing a right hepatectomy. Other studies have evaluated liver volumes at 3, 6, and 12 months postoperatively and found that disruption of the MHV during a major hepatectomy does not impair liver function [11].…”

Section: Discussionmentioning

confidence: 99%

“…One of the phenomena leading to PHLF in cases where the MHV is resected is the development of portal hypertension since the venous flow is redirected as the portal vein works as a refluxing vein [ 3 ]. Such an increase in portal pressure can cause endothelial damage and reduce liver regeneration, ultimately resulting in small-for-size syndrome.…”

Section: Introductionmentioning

confidence: 99%

Influence of middle hepatic vein resection during right or left hepatectomy on post hepatectomy outcomes

Nutu

Wilson

Ross

et al. 2022

Ann Hepatobiliary Pancreat Surg

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Backgrounds/Aims Middle hepatic vein (MHV) is usually preserved as a part of the right or left hepatectomy in order preserve the venous outflow of remnant liver. The aim of this study was to evaluate if resection of MHV could influence post-resection outcomes of standard right or left hepatectomy. Methods Patients who underwent standard right or left hepatectomy between January 2015 and December 2019 were included. Anatomical remnant liver volumes were measured retrospectively using the Hermes workstation (Hermes Medical Solutions AB, Stockholm, Sweden). Uni- and multi-variate analyses were performed to assess the difference in outcomes of those with preservation of MHV and those without preservation. Results A total of 144 patients were included. Right hepatectomy was performed for 114 (79.2%) and left hepatectomy was performed for 30 (20.8%) patients. MHV was resected for 13 (9.0%) in addition to the standard right or left hepatectomy. Median remnant liver volume was significantly higher in the MHV resected group ( p < 0.01). There was no significant difference in serum level of bilirubin, international normalized ratio, alanine aminotransferase, creatinine on postoperative day 1, 3, 5, or 10, ≥ grade IIIa complications ( p = 0.44), or 90-day mortality ( p = 0.41). On multivariable analysis, resection of the MHV did not influence the incidence of post hepatectomy liver failure ( p = 0.52). Conclusions Resection of the MHV at standard right or left hepatectomy did not have a negative impact on postoperative outcomes of patients with adequate remnant liver volume.

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Comparison of Regeneration of Remnant Liver After Hemihepatectomy with or Without the Middle Hepatic Vein

Abstract: In this study, the MHV should be preserved or reconstructed whenever possible during hepatic hemihepatectomy. Hepatic regeneration in the MHV perfusion region becomes poor within 7 days to 1 month after surgery (UMIN000023714).

Cited by 10 publications

References 36 publications

The Management of Recurrence within Six Months after Hepatic Resection for Colorectal Liver Metastasis

The Management of Recurrence within Six Months after Hepatic Resection for Colorectal Liver Metastasis

Right Hemihepatectomy via an Anterior Approach for Hepatocellular Carcinoma in a Situs Inversus Totalis Patient

Influence of middle hepatic vein resection during right or left hepatectomy on post hepatectomy outcomes

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