Limited Central Hepatectomy for Centrally Located Tumors: Is There a Place for Standardization?

Abstract

Anatomical central hepatectomy is technically demanding and is often excessive. It has an increased risk for insufficient remnant liver volume, especially in case of P8 dorsal pedicle for segment 7 and/or P5 dorsal for segment 6, and/or abnormal background liver. On the contrary, limited central hepatectomy (LCH) for centrally located tumors, based on preserving the P8 dorsal and some of P5 and P4 pedicles (depending on tumor placement) is conservative, and therefore has a low risk for insufficient remnant liver volume. It is less technically demanding, when compared to anatomical central hepatectomy. The right side of the resection plane is driven along the P8 dorsal pedicle intersecting the P8 ventral pedicle and as few of the P5 pedicles as possible. The left side of the resection plane is established according to tumor placement anywhere in between the Cantlie's plane and the falciform ligament. The video presents 5 cases that support the conclusion that LCH may be standardized, with good results, especially when using intraoperative ultrasound guidance.

Parenchyma-Sparing Liver Resection or Regenerative Liver Surgery: Which Way to Go?

“…IOUS guides the right transection plane along the P8 dorsal, intersecting the P8 ventral and as few P5 pedicles as possible. The left transection plane is settled relative to tumor position between Cantlie’s line and the falciform ligament [ 29 ]; left anterior sectorectomy, as an alternative to left hepatectomy for lesions invading the distal part of the umbilical portion of the left portal vein–resection of S3 and S4 inferior, while preserving the P2 and P4 superior. …”

“…IOUS guides the right transection plane along the P8 dorsal, intersecting the P8 ventral and as few P5 pedicles as possible. The left transection plane is settled relative to tumor position between Cantlie’s line and the falciform ligament [ 29 ];…”

“…As it is still a major hepatectomy, central hepatectomy is, however, to be avoided whenever possible. A feasible alternative is the systematic limited central hepatectomy [ 29 ].…”

“…The current practice involves performing parenchyma sparing, preferably anatomic LR, such as sub-segmentectomies, segmentectomies, bisegmentectomies, right posterior sectionectomy or central hepatectomy [ 89 ]. In case this is not feasible, non-anatomic LR such as SERPS [ 24 ] or systematic limited central hepatectomy [ 29 ] are options to be deployed whenever possible to avoid a major hepatectomy.…”