Pont hepatique (hepatic bridge), an important anatomic structure in cytoreductive surgery

Abstract

Cancer dissemination on peritoneal surfaces can be treated by cytoreductive surgery and perioperative intraperitoneal chemotherapy. To maximize benefits a complete cancer removal precedes the chemotherapy treatments. During cytoreductive surgical procedures a variable bridge of liver parenchyma that covers the round ligament of the liver was observed. This bridge of liver parenchyma is referred to as the pont hepatique (hepatic bridge). Failure to remove tumor nodules from beneath the pont hepatique will result in recurrent disease. If the pont hepatique is opened as part of a cytoreductive procedure for peritoneal dissemination of cancer, cancer nodules will often be found beneath. These nodules can be removed using electrosurgical dissection taking care to avoid damage to the left hepatic artery. Division of the pont hepatique and removal of cancer nodules around and on the round ligament will facilitate a complete cytoreduction.