Jean-Baptiste Cazauran1, Lucas Pâris1, Pascal Rousset2,3, Frédéric Mercier1, Vahan Kepenekian1, Anthony Viste4,5, Guillaume Passot6,7. 1. Hospices Civils de Lyon, Department of Surgical Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France. 2. Hospices Civils de Lyon, Department of Radiology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France. 3. EMR 3738, Claude Bernard University, Lyon 1, Lyon, France. 4. Faculté de Médecine Lyon Sud-Charles Mérieux, Laboratoire d'Anatomie, Université de Lyon, Chemin du Petit Revoyet, 69600, Oullins, France. 5. Department of Orthopaedic Surgery, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France. 6. Hospices Civils de Lyon, Department of Surgical Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France. guillaume.passot@chu-lyon.fr. 7. EMR 3738, Claude Bernard University, Lyon 1, Lyon, France. guillaume.passot@chu-lyon.fr.
Abstract
BACKGROUND: Surgery remains the gold standard both for delimited hepatocellular carcinoma by selective anatomic liver segentectomy and for colorectal liver metastases by parenchymal sparing liver resection. Right anterior sector (RAS) (segments V-VIII; Couinaud) is the largest and most difficult sector to operate on. A better knowledge of its segmentation could prevent postoperative remnant liver ischemia and its impacts on patient's survival. METHODS: A literature search was conducted in PubMed for papers on anatomy and surgery of the right anterior sector. RESULTS: Segmentation of the RAS depended of the anatomic variations of the third-order portal branches. Cranio-caudal segmentation was the most commonly found (50-53%), followed by ventro-dorsal (23-26%), trifurcation (13-20%), and quadrifurcation types (5-11%). Ventral and dorsal partial or total subsegmentectomy seemed accessible in 47 to 50% of patients, including bifurcation, trifurcation, and quadrifurcation types, and could spare up to 22% of the total liver volume. The RAS hepatic vein was present in 85-100% of the patients and could be used as a landmark between RAS dorsal and ventral part in 63% of patients. Reported overall morbidity rate of RAS subsegmentectomy ranged from 33 to 59% among studies with a postoperative major complication rate (Clavien-Dindo ≥ III) ranging around 18% and a biliary leakage rate from 16 to 21%. In-hospital reported mortality rate was low (0-3%), and results were comparable to "classic" liver resections. RAS subsegmentectomy remains a complex procedure; median operating time ranged from 253 to 520 min and median intraoperative blood loss reached 1255 ml. CONCLUSION: Better knowledge of RAS anatomy could allow for parenchymal preservation by using subsegmentectomy of the RAS, selective or as a part of a major hepatectomy.
BACKGROUND: Surgery remains the gold standard both for delimited hepatocellular carcinoma by selective anatomic liver segentectomy and for colorectal liver metastases by parenchymal sparing liver resection. Right anterior sector (RAS) (segments V-VIII; Couinaud) is the largest and most difficult sector to operate on. A better knowledge of its segmentation could prevent postoperative remnant liver ischemia and its impacts on patient's survival. METHODS: A literature search was conducted in PubMed for papers on anatomy and surgery of the right anterior sector. RESULTS: Segmentation of the RAS depended of the anatomic variations of the third-order portal branches. Cranio-caudal segmentation was the most commonly found (50-53%), followed by ventro-dorsal (23-26%), trifurcation (13-20%), and quadrifurcation types (5-11%). Ventral and dorsal partial or total subsegmentectomy seemed accessible in 47 to 50% of patients, including bifurcation, trifurcation, and quadrifurcation types, and could spare up to 22% of the total liver volume. The RAS hepatic vein was present in 85-100% of the patients and could be used as a landmark between RAS dorsal and ventral part in 63% of patients. Reported overall morbidity rate of RAS subsegmentectomy ranged from 33 to 59% among studies with a postoperative major complication rate (Clavien-Dindo ≥ III) ranging around 18% and a biliary leakage rate from 16 to 21%. In-hospital reported mortality rate was low (0-3%), and results were comparable to "classic" liver resections. RAS subsegmentectomy remains a complex procedure; median operating time ranged from 253 to 520 min and median intraoperative blood loss reached 1255 ml. CONCLUSION: Better knowledge of RAS anatomy could allow for parenchymal preservation by using subsegmentectomy of the RAS, selective or as a part of a major hepatectomy.
Authors: Chandrakanth Are; Mithat Gonen; Kathleen Zazzali; Ronald P Dematteo; William R Jarnagin; Yuman Fong; Leslie H Blumgart; Michael D'Angelica Journal: Ann Surg Date: 2007-08 Impact factor: 12.969
Authors: Jonathan Geograpo Navarro; Gi Hong Choi; Myoung Soo Kim; Yoon Bin Jung; Jae Geun Lee Journal: Medicine (Baltimore) Date: 2019-05 Impact factor: 1.817