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KMID : 0870419970010010081
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
1997 Volume.1 No. 1 p.81 ~ p.88
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Clinical Significance of Preserving the Draining Vein in the Remnant Liver
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Wang Hee-Jung
Lee Hyuck-Sang
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Abstract
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There has been a recent increase of systematic limited resection for hepatocellular carcinoma in patients with compromised functional reserve of the liver due to coexistence of chronic liver disease. The ultimate goal of this type of resection is to save the marginal amount of noncancerous hepatic mass while radically removing the cancerous tissues. When the tumor is located in close proximity to the right hepatic vein, i.e. segment Ⅶ or Ⅷ, it often becomes necessary to remove the vein along with the tumor. The issue here is the fate of segment Ⅵ without its major draining vein. We experienced four cases of Ⅶ +Ⅷ segmentectomy for hepatocellular carcinoma associated with cirrhosis; in first three cases the main trunk of the right hepatic vein was sacrificed and in one case it was preserved. Of the first three cases, Two required additional resection of segment Ⅵ because of congestion of the remnant segment without drainage vein, or uncontrollable bleeding from the cut surface. In the remaining case of the three, a large(about 5㎜ in diameter) inferior right hepatic vein draining segment Ⅵ directly to the ⅣC was identified and preserved. In this case, segment Ⅵ was reserved without any congestion or bleeding. The last case involved Ⅶ+Ⅷ segmentectomy with preservation of right hepatic vein with no complications from segment Ⅵ. These results suggest that, in addition to being prone to bleed and not to function at least in the early postoperative period, a segment of the liver left without any draining vein may lead to liver failure in cirrhotic patients with marginal functional reserve of the liver.
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KEYWORD
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Hepatic Venous Preservation, Hepatectomy, Hepatocellular Carcinoma
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