J.Jpn. Surg. Soc.. 87(9): 1156-1159, 1986

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Report on the annual meeting

LIMITATION OF INTRAHEPATIC GLISSONIAN VESSELS TO HEPATIC RESECTIONAL RANGE

The long-term survival rate after hepatectomies for small hepatocellular carcinomas (HCC) is not clinically acceptable enough to consider small HCCs as early cancers. This suggests that extended resections are advisable to cure even small HCCs, which have a high incidence of vascular invasion.
The present study was undertaken to clarify how much the resectional extent is limited anatomically by the intrahepatic major Glissonian branches. The distance from the parietal surface of each subsegment (S54-58) to the first branching point of the right portal pedicle (P-point) was measured by taking serial CT slices of 23 cirrhotic patients who averaged 60 years in age and 165cm in height.
The CT measured distances from S6 and S5 were 9.1 ± 1.6cm and 8.2 ± 1.6cm (M ± SD), respectively, further than about 7cm of those from S4, S7 and S8. The anatomical differences found between subsegments were refiected in the difference in the distance from the surgical margins to the tumor edges (TW), measured in the specimens (n＝49) obtained with subsegmental resections. Namely, the TWs gained by resections for S5 or S6 were longer than those for S4, S7 or S8. These findings show that the inferior parts of the liver with potentially longer TWs are more favorable target areas for subsegrnental resection in comparison with the superior or S4 parts which are closer to not only the P-point but also the hepatic vein trunk.

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