Clinical analysis of right anterior segmentectomy for hepatic malignancy.

ABSTRACT

BACKGROUND/AIMS: Combined resection of segments 5 and 8, or right anterior segmentectomy, is one of the most difficult hepatic resections because of the danger of bleeding from the two major hepatic veins, the middle and right hepatic veins, during hepatectomy. We describe here the operative procedure and clinical analysis of right anterior segmentectomy in 35 patients with hepatic malignancy. METHODOLOGY: Between March 1993 and December 2004, 35 patients underwent right anterior segmentectomy for hepatic malignancy. The technique used was based on the extraglissonian approach and parenchymal Kelly crushing, during which the two major hepatic veins were almost fully exposed. RESULTS: Thirty-three patients had hepatocellular carcinoma, one had peripheral cholangiocellular carcinoma, and one had primary hepatic sarcoma. The mean operation time was 331 +/- 73 minutes and the mean transfusion of packed RBC was 1.09 +/- 1.57 pints. There was one in-hospital death as a result of sepsis and hepatic failure. The cumulative 1-, 2- and 5-year survival rates were 94%, 72% and 62%, respectively. CONCLUSIONS: For surgeons who accurately know the anatomy of the liver, this procedure is safe and suitable in selected patients with hepatic malignancies and may increase the survival rate.