Abstract
Background: Liver tumors invading the distal part of the umbilical portion of the left portal vein usually require left hepatectomy. The recent introduction of the concept of left anterior sector, an independent anatomo-functional unit including the anterior portion of the left liver and supplied by the distal part of the umbilical portion of the left portal vein, could represent the rational for an alternative surgical approach. The aim of this study was to introduce the novel surgical procedure of ultrasound-guided left anterior sectorectomy. Methods: Among 92 consecutive patients who underwent hepatectomy, 3 patients with tumor invading the distal part of the umbilical portion of the left portal (two with colorectal liver metastases and one with neuroendocrine tumor liver metastases) underwent left anterior sectorectomy alone or in association with liver multiple metastasectomies. Results: Mean operation time was 393 min; post-operative morbidity and mortality were not observed. After a mean FU of 23 months (range 19–28), no local recurrence occurred. Conclusions: In presence of tumors invading the distal part of the umbilical portion of the left portal, left anterior sectorectomy could be considered as an anatomic radical surgical option that is safe but more conservative than a left hepatectomy.
Highlights
The surgical treatment of tumors invading the distal part of the umbilical portion of the left portal vein (UPLPV) may represent a challenge for liver surgeons (Figure 1a).The presence of tumors with certain or suspected invasion of the UPLPV, when suitable for surgery, requires a radical anatomical liver resection with removal of the tumor, the invaded vessel, and the portion of parenchima supplied by that vessel; the traditional radical surgical approach in such cases is represented by a major resection, the left hemihepatectomy (Figure 1b).a modern approach in liver surgery needs to balance the oncological radicality with the aim to minimize the volume of liver to be resected [1,2]
The aim of the present study to introduce the surgical procedure of removal the treatment of patients with tumorswas invading the UPLPV, we recently performed an of the for presence of tumor invading the distal part of the UPLPV: the left anterior anatomo/radiological study and introduced the novel anatomical concept of left anterior sectorectomy sector (LAS), an(Figure independent anatomo/functional unit corresponding to the anterior portion of the left hemiliver, including segment 3 (S3) and S4 inferior (S4b), and supplied by an independent sectorial portal pedicle (PP) represented by the distal part of the UPLPV downstream from the origin of independent PPs for left posterior segments (S2 and S4a) [7] (Figure 1c)
The aim of the present study was to introduce the surgical procedure of removal of the LAS for presence of tumor invading the distal part of the UPLPV: the left anterior sectorectomy (Figure 1d)
Summary
The surgical treatment of tumors invading the distal part of the umbilical portion of the left portal vein (UPLPV) may represent a challenge for liver surgeons (Figure 1a).The presence of tumors with certain or suspected invasion of the UPLPV, when suitable for surgery, requires a radical anatomical liver resection with removal of the tumor, the invaded vessel, and the portion of parenchima supplied by that vessel; the traditional radical surgical approach in such cases is represented by a major resection, the left hemihepatectomy (Figure 1b).a modern approach in liver surgery needs to balance the oncological radicality with the aim to minimize the volume of liver to be resected [1,2]. The surgical treatment of tumors invading the distal part of the umbilical portion of the left portal vein (UPLPV) may represent a challenge for liver surgeons (Figure 1a). With the aim to identify alternative and more conservative surgical procedures for the treatment of patients with tumors invading the UPLPV, we recently performed an anatomo/radiological study and introduced the novel anatomical concept of left anterior 4.0/). The recent introduction of the concept of left anterior sector, an independent anatomo-functional unit including the anterior portion of the left liver and supplied by the distal part of the umbilical portion of the left portal vein, could represent the rational for an alternative surgical approach. Methods: Among 92 consecutive patients who underwent hepatectomy, 3 patients with tumor invading the distal part of the umbilical portion of the left portal (two with colorectal liver metastases and one with neuroendocrine tumor liver metastases) underwent left anterior sectorectomy alone or in association with liver multiple metastasectomies
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
