Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Parenchymal-sparing anatomical hepatectomy based on portal ramification of the right anterior section: A prospective multicenter experience with short-term outcomes

  • Truong Giang Nguyen (Department of Hepatobiliary Surgery, National Hospital of Tropical Diseases) ;
  • Thanh Khiem Nguyen (Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital) ;
  • Ham Hoi Nguyen (Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital) ;
  • Hong Son Trinh (Department of Oncology, Viet Duc University Hospital) ;
  • Tuan Hiep Luong (Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital) ;
  • Minh Trong Nguyen (Department of Hepatobiliary Surgery, National Hospital of Tropical Diseases) ;
  • Van Duy Le (Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital) ;
  • Hai Dang Do (Organ Transplantation Center, Viet Duc University Hospital) ;
  • Kieu Hung Nguyen (Department of Hepatobiliary Surgery, National Hospital of Tropical Diseases) ;
  • Van Minh Do (Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital) ;
  • Quang Huy Tran (Department of Anatomy, Hanoi Medical University) ;
  • Cuong Thinh Nguyen (108 Institute of Clinical Medical and Pharmaceutical Sciences)
  • Received : 2023.06.22
  • Accepted : 2023.08.16
  • Published : 2024.02.29
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Abstract

Backgrounds/Aims: Parenchymal-sparing anatomical hepatectomy (Ps-AH) based on portal ramification of the right anterior section (RAS) is a new technique to avoid unnecessarily transecting too much liver parenchyma, especially in cases of major anatomical hepatectomy. Methods: We prospectively assessed 26 patients with primary hepatic malignancies having undergone major Ps-AH based on portal ramification of the RAS from August 2018 to August 2022 (48 months). The perioperative indications, clinical data, intra-operative index, pathological postoperative specimens, postoperative complications, and follow-up results were retrospectively evaluated. Results: Among the 26 patients analyzed, there was just one case that had intrahepatic cholangiocarcinoma The preoperative level of α-Fetoprotein was 25.2 ng/mL. All cases (100%) had Child-Pugh A liver function preoperatively. The ventral/dorsal RAS was preserved in 19 and 7 patients, respectively. The mean surgical margin was 6.2 mm. The mean surgical time was 228.5 minutes, while the mean blood loss was 255 mL. In pathology, 5 cases (19.2%) had microvascular invasion, and in the group of HCC patients, 92% of all cases had moderate or poor tumor differentiation. Six cases (23.1%) of postoperative complications were graded over III according to the Clavien-Dindo system, including in three patients resistant ascites or intra-abdominal abscess that required intervention. Conclusions: Parenchymal-sparing anatomical hepatectomy based on portal ramification of the RAS to achieve R0-resection was safe and effective, with favorable short-term outcomes. This technique can be used widely in clinical practice.

Keywords

Acknowledgement

The authors were thankful to the board and colleagues of the Department of Gastrointestinal and Hepato-pancreato-biliary surgery, Bach Mai Hospital; the Department of Hepatobiliary-pancreatic Surgery, Vietnam National Cancer Hospital and the Department of Hepatobiliary Surgery, National Hospital of Tropical Diseases, Hanoi, Vietnam for their assistance during the time of in-hospital treatment and observation of our patients.

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