Anatomic resection of liver segments 6-8 for hepatocellular carcinoma

Figure 1 Preoperative imaging showed that segment 5 was free of tumor in all patients. A: Multiple tumors were found in segments 6, 7 and 8 by contrast-enhanced computed tomography scans (arrows) in Case 1; B: Huge tumor located in the right liver in Case 4. Arrow: Middle hepatic vein; Arrowhead: Right anterior portal vein; Triangular arrow: Right posterior portal vein; Curved arrow: Gallbladder.

Figure 2 Surgical procedures. A: Right hemihepatic Glissonean pedicle and segment 6 and 7 Glissonean pedicle in Case 4 were sequentially divided. Arrow: Segment 6 and 7 Glissonean pedicle; arrowhead: Segment 5 and 8 Glissonean pedicle; curved arrow: Right hemihepatic Glissonean pedicle; B: After occlusion of the right hemihepatic Glissonean pedicle in Case 4, the right liver showed obvious ischemia. The demarcation between the right and left liver could be easily determined (arrowheads); C: After the segment 6 and 7 Glissonean pedicle of Case 4 was ligated, segments 6 and 7 showed obvious ischemia. The interface between segments 6 and 5 could be easily demarcated. Arrow: Demarcation between segments 6 and 5 upon the diaphragmatic surface of the liver; Arrowheads: Demarcation between the right and left liver; Bold arrows: Demarcation between segments 6 and 5 on the visceral surface of the liver; Curved arrow: Fossa of gallbladder (C1, C2); D: Segment 5 was determined and a “┏┛” shaped broken resection line was marked upon the diaphragmatic surface of the liver in Case 4. Arrowheads: Demarcation between segments 5 and 8; Arrow: Segment 5.

Figure 3 Surgical results. A: After hepatectomy, the inflow and outflow of segment 5 were maintained. Triangular arrow: remnant segment 5 in Case 1; arrow: Remnant segment 5 in Case 4; B: Gross specimen showed that tumors in Case 4 were completely resected. Segments 6, 7 and 8 are indicated.