Segment oriented liver resections

1. SEGMENT ORIENTED LIVER RESECTIONS I. Popescu CENTER OF GENERAL SURGERY AND LIVER TRANSPLANTATION FUNDENI CLINICAL INSTITUTE BUCHAREST

4. 1954 CLAUDE COUINAUD

8. 1.01.1995 - 1 . 03 .200 3 569 hepatectomi es 552 patients 30 5 anatomical hepatectomies 137 segment oriented resections

9. 13 7 segment oriented liver resections 11 9 non-cirrhotic patients 18 cirrhotic patients

11. Segmentectomi es

12. Segment I 8 cases

13. Hemangiom a

15. Segment I I – 1 case Metasta sis from colonic cancer

16. Segment III

17. Segment III – 5 ca ses Hepatocellular carcinoma associated with cirrhosis

19. Segment IV

20. Segment V 8 ca ses Hepatic adenoma

21. Segment V- 8 ca ses Indications Benign lesions 3 Inflammatory tumor 1 Focal nodular hyperplasia 1 Hepatic adenoma 1 Malignant lesions 5 Hepatocellular carcinoma 2 1 ci rrhosis Metasta sis from colon cancer 2 Metasta sis from breast cancer 1

23. Segment V II - 1 case Hemangioma

24. Segment VIII - 3 ca ses FNH

26. Bisegmentectomi es

27. Left lateral sectorectomy (II, III) Intraparenchymal vascular approach

28. Extrahepatic vascular approach HCC with cirrhosis Left lateral sectorectomy (II, III)

30. Laparoscopic resection – 1 ca se Liver metastasis from breast cancer Left lateral sectorectomy

31. Harvesting of segments II-III from a living donor for a pediatric liver transplantation

32. Right lateral sectorectomy (VI, VII) 23 cases

34. Bisegmentectom y IVb, V 5 ca ses Gallbladder cancer sta ge II

35. Indica tions B enign lesions 2 Hemangiom a 1 Hamartom a 1 Mal ign ant lesions 3 Gallbladder cancer 3 Bisegmentectom y IVb, V – 5 ca ses

36. Right medial sectorectomy (V, VIII) 1 case Inflammatory tumor

37. Bisegmentectom y V, VI – 9 ca ses Liver m etasta sis from colonic cancer S IV S VIII S IV S VIII

39. Trisegmentectomi es

40. I nflam m ator y tumor with central necrosis located in segment s IV, V, VIII Total hepatic volume 1752,2 cm 3 Tumor volume 292 cm 3 3-D RECONSTRUCTION C entral hepatectomy 3 ca ses 2 inflammatory tumors 1 metastasis from colonic cancer

43. Transverse hepatectomy (IVb, V, VI) Gallbladder cancer Sta ge IVa 3 cases 2 gallbladder cancer 1 metasta sis breast cancer

44. Sub segmentectom ies

45. Segment IV b – 2 cases 1 non-parasitic cyst 1 metastasis from breast cancer IVb IVb IVb IVb

47. Morbidity 10% Mortality 0 Morbidity , mortality 0-7,6% Hemming A.W. – Am J Surg 1993; 165: 621-624 0 1 3 CH 0 0 3 TH 0 2 9 V, VI 0 0 5 IVb,V 0 0 1 RMS 0 5 23 RLS 0 3 64 LLS 0 0 1 II 0 1 3 VIII 0 0 1 VII 0 0 1 VI 0 0 8 V 0 0 2 IVb 0 0 5 III 0 2 8 I Deaths Complications Total Resection type

50. Segment oriented liver resections are well standardized operations, with a high level of difficulty but with proved benefits for the patient. Conclusion