Anatomic liver resection of segments 6, 7, and 8 by the method of selective occlusion of hepatic inflow.

Abstract

Anatomic liver resection not only enables enough tumor-free resection margin but also guarantees maximum preservation of remaining normal liver tissue. We report herein a hepatocellular carcinoma patient who underwent successful anatomic liver resection of segments 6, 7, and 8 by the method of selective occlusion of hepatic inflow. Multiple tumors were found in segments 6, 7, and 8 by computed tomographic (CT) scanning. CT volumetry analyzed that his left hemi-liver volume was less than the minimal limit of safe survival. Therefore, we planned to perform segment 5 remaining, anatomic liver resection of segments 6, 7, and 8 to guarantee the maximum preservation of remaining normal liver tissue. Selective occlusion of hepatic inflow was creatively used twice in this case to divide right hemi-liver Glissonean pedicle and segments 6 and 7 Glissonean pedicle, respectively. Thus, the resection line was determined, and anatomic liver resection of segments 6, 7, and 8 was completed. Selective right hemi-liver Glissonean pedicle occlusion was used, while parenchymal transection was between segments 6 and 5 and between segments 8 and 5. Therefore, liver ischemia reperfusion injury and homodynamic instability were maximally reduced during operation.