Resecting liver segments VII–VIII without reconstructing the right hepatic vein

Abstract

Aim. To improve outcomes of treatment for neoplasms in segments VII-VIII of the liver adjacent to the main stem of the right hepatic vein and/or to its forming large branches.Materials and methods. In the period of 2016–2022, the resection of segments VII and/or VIII of the liver and the right hepatic vein, as well as its forming branches without reconstruction was performed in 24 patients. Surgical indications were liver metastases of colorectal cancer in 15 cases, hepatocellular cancer (cholangiocarcinoma) in six cases, angiomyolipoma in one case, uterine cancer metastases in one case and primary retroperitoneal tumor metastases in one case. Minor liver resections were additionally performed in 11 cases. Results. There were no intraoperative signs of impaired venous drainage. After surgery bile in the drains was detected in three patients, and a biliary fistula was formed in one case. No other complications were identified. No fatalities were registered after surgery. The late postoperative period revealed no specific complications related to a disturbance of venous drainage through the right hepatic vein.Conclusion. Existing and emerging collaterals can provide adequate venous drainage to the middle hepatic vein, short hepatic veins after resection of liver segments VII and VIII with resection of the right hepatic vein stem and its forming branches without reconstruction, even if the lower right hepatic vein is missing, and without complete obstruction of the right hepatic vein before surgery.