Left anterior sectorectomy: A novel anatomical surgical procedure in the left liver

Abstract

Purpose: Presence of liver tumors invading the distal part of the umbilical portion of the left portal vein usually requires left hepatectomy. The introduction of the concept of left anterior sector, an independent anatomo-functional unit including segment 3, sub-segment 4b and supplied by the distal portion of left portal vein, could represent the rational for an alternative surgical approach. The aim of this study was to present the novel surgical procedure of the left anterior sectorectomy. Methods: A patient with neuroendocrine metastatic liver tumor invading the distal part of the umbilical portion of the left portal vein underwent to ultrasound-guided left anterior sectorectomy. Results: Mean operation time was 223 minutes, blood loss was 250 cc, no post-operative morbidity occurred. At the end of resection, segment 2 and subsegment 4a did not show any ischemic or congested area. The pathological analysis showed negative surgical margins. After a follow up of 16 months, no local recurrence occurred. Conclusions: The left anterior sectorectomy could be considered as an anatomical, radical, small for size surgical option in presence of liver tumors invading the umbilical portion of the left portal vein.