Right trisegmentectomy for hepatic neoplasms

Abstract

Thirty patients had right trisegmentectomy for 19 primary hepatic malignant tumors, seven localized liver metastases and four benign lesions. A technical refinement that aided resection of bulky posterior and superior tumors was intrahepatic identification and control of the right hepatic vein. The operative mortality was 3.3 per cent. Late hepatic insufficiency was not observed. More than one-half of the patients operated upon a year or more ago for primary hepatic malignant growths had a tumor-free state at the 12 month follow-up period. Beyond this time, there was only one recurrence. The results in children were twice as good as in adults. The results in treating localized liver metastases from distant primary sites were inferior to those in treating primary hepatic tumors. A hypothetical case was made for combining hepatic resection with adjuvant chemotherapy, even though our experience could not be construed as direct support for this practice.

Fig. 1

Control of right hepatic vein from within the liver. I.V.C., Inferior vena cava.

Fig. 2

a and b, Technical management of patient whose intrahepatic vena cava and left hepatic vein were invaded by tumor.