Clinical efficacy of hepatic vein drainage guided hepatectomy for hepatocellular carcinoma

Objective To investigate the clinical efficacy of hepatic venous drainage guided hepatectomy (HVDGH) for hepatocellular carcinoma. Methods The retrospective and descriptive study was conducted. The clinicopathological data of 10 patients with hepatocellular carcinoma who were admitted to Nanjing Drum Tower Hospital Affiliated to Nanjing University Medicine School from October 2015 to January 2018 were collected. There were 9 males and 1 female, aged from 35 to 68 years, with an average age of 57 years. Three-dimensional reconstruction of liver, hepatic vasculature, and carcinoma was performed in the 10 patients to evaluate the anatomy and variation of hepatic vasculature, and the spatial relationship between carcinoma and hepatic vasculature. Patients were performed right HVDGH, middle HVDGH, left and middle HVDGH, according to their conditions. Observation indicators: (1) preoperative three-dimensional reconstruction and planning; (2) surgical and postoperative conditions; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis of patients up to May 2018. Measurement data with normal distribution were described as average (range), and count data were described as absolute numbers. Results (1) Preoperative three-dimensional reconstruction and planning: of the 10 patients, 3 had the tumor located at S4 of the liver, 1 had the tumor located at S4 and S8 of the liver, 1 had the tumor located at S5, S6, and S7 of the liver, 4 had the tumor located at S6 and S7 of the liver, 1 had the tumor located at S6, S7, and S8 of the liver. All the 10 patients had tumor close to the main hepatic vein with a distance <5 mm, including 6 with the tumor adjacent to the right hepatic vein, 1 adjacent to the middle hepatic vein, and 3 adjacent to the left hepatic vein and the middle hepatic vein. The tumor diameter was 7.3 cm (range, 4.0-13.5 cm). The residual liver volume/standard liver volume (RLV/SLV) of 10 patients undergoing hepatic vein-preserving hepatectomy was 36.2% (range, 22.0%-46.0%), of which 7 had RLV/SLV less than 40.0%. The RLV/SLV of 10 patients undergoing HVDGH was 51.9% (range, 40.0%-61.0%). (2) Surgical and postoperative conditions: all the 10 patients underwent HVDGH successfully, including 6 with tumor adjacent to right hepatic vein undergoing right HVDGH, 1 with tumor adjacent to middle hepatic vein undergoing middle HVDGH, 3 with tumor adjacent to left and middle hepatic vein undergoing left and middle HVDGH. The operation time, volume of intraoperative blood loss, and the distance between surgical margin and carcinoma were 350 minutes (range, 240-470 minutes), 525 mL (range, 200-1 000 mL), and 8.3 mm (range, 5.0-20.0 mm). There was no postoperative complication such as hemorrhage, liver failure, or biliary fistula in 10 patients. The duration of postoperative hospital stay was 13 days (range, 11-21 days). (3) Follow-up: 10 patients were followed up for 4-31 months, with a median follow-up time of 18 months. During the follow-up period, 10 patients were generally in good condition, and no tumor recurrence or metastasis occurred. Conclusions HVDGH is safe and effective for the treatment of hepatocellular carcinoma, which can be programmed by preoperative three-dimensional reconstruction software. For tumors adjacent to or invading hepatic veins, HVDGH can not only retain more liver parenchyma, but also obtain ideal resection margin. Key words: Hepatic neoplasms; Hepatic carcinoma; Hepatic venous drainage area; There-dimensional reconstruction; Hepatectomy; Congestion