Systematic extended right posterior sectionectomy (SERPS), a single center serial cases for secondary liver tumors

Abstract

Introduction and importance: Liver resection in secondary liver tumors may associated with the consequences of posthepatectomy liver failure (PHLF). Systematic extended right posterior sectionectomy (SERPS) is offered as an alternative to resect secondary liver tumors in segment 6–7 with vascular invasion of right hepatic vein, with less risk of PHLF compared to right hepatectomy. This case series is important to demonstrate the effectivity and safety of SERPS procedure performed in developing country. Cases presentation: The authors reported the case of four patients that underwent SERPS procedure due to metachronous and synchronous liver metastases caused by gastric gastrointestinal stromal tumor and colorectal cancer. Thulium doped fiber laser and harmonic scalpel were used as an energy device. Intra and postoperative parameters were evaluated. SERPS data was collected in 2020–2021 at Prof. dr. R.D. Kandou General Hospital. There were no postoperative complications and no tumor recurrences were found in all four patients in two years surveillance. Clinical discussion: Liver resection poses a relatively moderate risk of mortality and morbidity. Nowadays, parenchyma-sparing liver surgery is the procedure of choice compared to major liver resection whenever feasible. SERPS was first developed to minimize the need for major resection. SERPS may serve as a first-choice procedure due to its superior safety and comparable effectivity compared to major hepatectomy. Conclusion: SERPS is a safe and promising alternative for secondary liver tumors at segments 6–7 and right hepatic vein vascular invasion, compared to right hepatectomy. Thus, minimizing the risk of PHLF by saving a larger volume of future liver remnant.