Technical Problems of Anatomical Hepatic Resection for Hepatocellular Carcinoma with Special Reference to Factors Relating to Tumor and Vasuclar Structure

Masahiro Tominaga, Yonson Ku, Yoichi Saitoh

First Department of Surgery, Kobe University School of Medicine

We investigated the technical feasibility of anatomical hepatic resection (AHx) for hepatocellular carcinoma (HCC) with special reference to factors relating to tumor and vascular structure. According to the method of hepatectomy, patients were categorized into two groups: A, AHx, n=43; B, non-AHx (NAHx), n=35. With respect to tumor site, there was no significant difference between the two groups. However, among patients treated by limited hepatectomy of less than HrS, NAHx tended to be more frequently performed for s7 and s8 tumors. With respec to tumor location in each subsegment, centrally located tumors tended to be more frequent in group A than in group B, while marginally located tumors tended to be more frequent in group B than in group A. With HrS, these differences between the two groups became statistically significant (p<0.05). For intrahepatic metastases, extended resection was chosen in group A, whereas partial resection for each lesion was selected in group B due to impaired hepatic function. Patients with tumors located close to the deep vascular bifurcation were all treated by NAHx. In addition, patients with tumors having third- to fourth-order vascular pedicles from two or more adjacent subsegments and patients with non-standard bifurcation at the third order tended to be treated by NAHx. These results indicate that AHx can't always be applied for HCC due to factors relating to tumor and vascular structure. Therefore, the feasibility of AHx should be carefully determined with the aid of preoperative imaging techniques.

Key words
hepatocellular carcinoma, anatomical hepatic resection, hepatic segment

Reprint requests
Yonson Ku First Department of Surgery, Kobe University School of Medicine
7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650 JAPAN

Accepted
April 13, 1994

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