Extended central hepatectomy with preservation of segment 6 for patients with centrally located hepatocellular carcinoma

Comparative study on three-dimensional versus two-dimensional imaging using a computer-assisted surgery system for preoperative planning in pediatric middle hepatic tumors

BACKGROUD

The study objective was to compare three-dimensional and two-dimensional imaging using computer-assisted systems (CASs) in clinical guidance for preoperative surgical planning for middle hepatic tumors in children.

METHODS

A retrospective analysis was performed on 23 children who underwent surgery for middle hepatic tumors in our hospital from January 2016 to June 2022. The surgical resection plan was formulated by the operator team using two-dimensional CT images before the operation. Then, the same qualified surgeons conducted an in-depth analysis and formulated the surgical resection scheme for the same pediatric patient using three-dimensional imaging of the middle hepatic tumor. The feasibility of the two schemes was compared and analyzed.

RESULT

All the tumors were successfully removed according to the preoperative method developed using three-dimensional imaging. The postoperative short-term follow-up revealed that all patients were doing well. Preoperative plans were revised in 9 cases after evaluating the three-dimensional images due to the disparity between the original plans and the three-dimensional relationship between the tumor and blood vessels, vascular variation, and the volume of remnant liver.

CONCLUSIONS

Three-dimensional imaging with a computer-assisted surgery system is superior to two-dimensional imaging in the preoperative planning of pediatric hepatoblastoma.

Right hepatic vein reconstruction in middle hepatectomy: A case report

Background

Surgical resection is the only treatment modality that ensures complete tumor removal in patients with liver tumors involving a major hepatic vein. Central hepatectomy is a challenging procedure that often result in large defect at the right hepatic vein, which is not amenable to suturing or end-to-end anastomosis. Meanwhile, good outflow reconstruction is essential for early postoperative recovery and long-term survival.

Methods

We describe a simple technique for reconstructing the right hepatic vein. The technique is an effective method for reconstructing large venous defects after the hepatic vein resection. Reconstruction of the right hepatic vein has the advantages of prevention of congestion in segments VI and VII.

Conclusions

This technique allows surgeons to reconstruct the hepatic vein without synthetic vascular grafts and cryopreserved veins.

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A new technique is a simple and effective method to reconstruct large vein defects after the hepatic vein resection without synthetic vascular grafts and cryopreserved vein.

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Reconstruction of the RHV has the advantages of prevention of congestion at segments 6 and 7.

A novel technique for hepatic vein reconstruction during hepatectomy

Surgical resection is the treatment of choice for malignant liver tumours. Nevertheless, surgical approach to tumours located close to the confluence of the hepatic veins is a challenging issue. Trisectionectomies are considered the first curative option for treatment of these tumours. However, those procedures are associated with high morbidity and mortality rates primarily due to post-operative liver failure. Thus, maximal preservation of functional liver parenchyma should always be attempted. We describe the isolated resection of Segment 8 for the treatment of a tumour involving the right hepatic vein and in contact with the middle hepatic vein and retrohepatic vena cava with immediate reconstruction of the right hepatic vein with a vascular graft. This is the first time this type of reconstruction was performed, and it allowed to preserve all but one of the hepatic segments with normal venous outflow. This innovative technique is a fast and safe method to reconstruct hepatic veins.