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

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.

1. Araujo, Raphael & Linhares, Marcelo. (). Pushing the limits of liver surgery for colorectal liver metastases: Current state and future directions. World Journal of Gastrointestinal Surgery 2019; 11. 34-40. 10.4240/wjgs.v11.i2.34.

2. Are C, Gonen M., Zazzali K., Dematteo R.P., Jarnagin W.R., Fong Y., Blumgart L.H., D'Angelica M. The impact of margins on outcome after hepatic resection for colorectal metastasis. Ann. Surg. 2007; 246: 295-300 PMID: 17667509 DOI: 10.1097/SLA.0b013e31811ea962

3. Memeo R., de Blasi V., Adam R., Goéré D., Piardi T., Lermite E., Turrini O., Navarro F., de'Angelis N., Cunha A.S., Pessaux P. French Colorectal Liver Metastases Working Group, Association Française de Chirurgie (AFC). Margin Status is Still an Important Prognostic Factor in Hepatectomies for Colorectal Liver Metastases: A Propensity Score Matching Analysis. World J. Surg. 2018; 42: 892-901 [PMID: 28929341; DOI: 10.1007/s00268-017-4229-7]

4. Tani K, Ishizawa T, Sakamoto Y, Hasegawa K, Kokudo N. Surgical Approach to “Right Hepatic Core”: Deepest Region Surrounded by Major Portal Pedicles and Right Hepatic Vein. Digestive Surgery [Internet]. S. Karger AG; 2017 Nov 28;35(4):350–8. Available from: http://dx.doi.org/10.1159/000485138

5. Sadamori H, Hioki M, Monden K et al. Right Hepatic Vein Reconstruction with an Autologous Jugular Vein Graft to Expand the Surgical Indications for Liver Tumors. Journal of Gastrointestinal Surgery. 2019;23(12):2467-2467. doi:10.1007/s11605-019-04349-z 6. Nakamura S. Hepatic Vein Reconstruction for Preserving Remnant Liver Function. Archives of Surgery. 1990;125(11):1455. doi:10.1001/archsurg.1990.01410230049009

6. Nakayama H, Takayama T, Higaki T, Okubo T, Moriguchi M, Yoshida N, Kuronuma A. Verification of inferior right hepatic vein-conserving segments 7 to 8 resection of the liver. Int Surg. 2015 Apr;100(4):683-8. doi: 10.9738/intsurg-d-14-00183.1.

7. Makuuchi M, Hasegawa H, Yamazaki S, Takayasu K. Four new hepatectomy procedures for resection of the right hepatic vein and preservation of the inferior right hepatic vein.SurgGynecol Obstet. 1987;164(1):68-72. PMID:3026059

8. Champetier J, Haouari H, Le Bas J, Létoublon C, Alnaasan I, Farah I. Large inferior right hepatic vein. Surgical and Radiologic Anatomy. 1993;15(1):21-29. doi:10.1007/bf01629857

9. Schwarz L, Hamy A, Huet E, Tuech J. Large inferior right hepatic vein preserving liver resection. J Visc Surg. 2017;154(1):65-67. doi:10.1016/j.jviscsurg.2016.12.003

10. Couinaud C. Le Foie: E´tudes Anatomiqueset Chirurgicales. New York: Masson Publishers; 1957.

11. Алиханов Р. Б., Кубышкин В. А.. Дубровский А. В., Ефанов М. Г. Реконструкция печеночных вен при резекциях печени. Техника и оценка возможности профилактики пострезекционной печеночной недостаточностиХирургия. Журнал им. Н.И. Пирогова. 2016;(3): 56-58 [Alikhanov R, Kubishkin V, Dubrovskiy A, Efanov M.Reconstruction of hepatic veins in liver resection.Technique and possibility of prophylaxis of posthepatectomy liver failure. KhirurgiyaZhurnalim NI Pirogova.2016;(3):56. doi:10.17116/hirurgia2016356-586 (13). (in Russ).] doi:10.1001/archsurg.1990.01410230049009

12. Hamy A, d'Alincourt A, Floch I, Madoz A, Paineau J, Lerat F. Bisegmentectomie 7–8 : intérêt du repéragepré-opératoired'uneveinehépatiqueinférieuredroite (VHID). Ann Chir. 2004;129(5):282-285. doi:10.1016/j.anchir.2004.02.007

13. Ou QJ, Hermann RE. The role of hepatic veins in liver operations. Surgery 1984;95:381–91

14. Xie Y, Dong J, Wang Y, Leng J. Resection and Reconstruction of the Right Hepatic Vein With Combined S4, S7 and S8 Segmentectomy. Asian J Surg. 2009;32(4):247-252. doi:10.1016/s1015-9584(09)60402-4

15. Yu N, Raman S, Kim Y, Lassman C, Chang X, Lu D. Microwave Liver Ablation: Influence of Hepatic Vein Size on Heat-sink Effect in a Porcine Model. Journal of Vascular and Interventional Radiology. 2008;19(7):1087-1092. doi:10.1016/j.jvir.2008.03.023

16. Huang S, Yu J, Liang P et al. Percutaneous microwave ablation for hepatocellular carcinoma adjacent to large vessels: A long-term follow-up. Eur J Radiol. 2014;83(3):552-558. doi:10.1016/j.ejrad.2013.12.015

17. Lee J, Shin IS, Yoon WS, Koom WS, Rim CH. Comparisons between radiofrequency ablation and stereotactic body radiotherapy for liver malignancies: Meta-analyses and a systematic review. RadiotherOncol. 2020 Jan 7;145:63-70. DOI:https://doi.org/10.1016/j.radonc.2019.12.004

18. Shilal P. Anatomical Variations in the Pattern of the Right Hepatic Veins Draining the Posterior Segment of the Right Lobe of the Liver. Journal of clinical and diagnostic research. 2015. doi:10.7860/jcdr/2015/8736.5671

19. Kaneko T, Kaneko K, Sugimoto H et al. Intrahepatic anastomosis formation between the hepatic veins in the graft liver of the living related liver transplantation: observation by doppler ultrasonography. Transplantation. 2000;70(6):982-985. doi:10.1097/00007890-200009270-00018

20. Machado M, Herman P, Makdissi F, Figueira E, Bacchella T, Machado M. Feasibility of bisegmentectomy 7–8 is independent of the presence of a large inferior right hepatic vein. J SurgOncol. 2006;93(4):338-342. doi:10.1002/jso.20476

21. Wang X., Lei Y., Huan H., Chen S,. Ma K., Feng K., Lau WY and Xia F. Bisegmentectomy 7–8 for Small-for-Size Remanant Liver for Cirrhotic Patients Under Right Hemi-hepatectomy With Hepatocellular Carcinoma: A Case-Matched Comparative Study. Front. Surg. 2021; 8:675666. doi: 10.3389/fsurg.2021.675666