Ann Hepatobiliary Pancreat Surg.  2024 Nov;28(4):522-526. 10.14701/ahbps.24-092.

Segments 4, 7, and 8 liver resection: A case report

• Leal-Leyte P
• Camarillo-Sánchez CU
• Zamora-Valdés D

• KMID: 2561586
• DOI: http://doi.org/10.14701/ahbps.24-092

Abstract

Right superior resection (segments 7 and 8) is an uncommon resection for liver malignancies, with most of the literature limited to case reports and small series. Resection of segments 4, 7, and 8 has been reported in only a few cases. When the right hepatic vein is resected, venous reconstruction or identification of one or more right inferior hepatic veins is considered mandatory, to maintain segmentary function of segments 5 and 6. We present a case of liver resection of segments 4, 7, and 8 including the right and middle hepatic veins for symptomatic benign liver disease with no right hepatic vein reconstruction, nor a prominent right inferior hepatic vein(s). After the resection, there was no change in liver function tests, and the patient made an unremarkable recovery. Three months after the operation, partial atrophy of segments 5 and 6 with hypertrophy of the left lateral section was observed, while two and one half years after resection, the patient is asymptomatic. When right hepatic vein reconstruction would add unnecessary operative time, and there is low likelihood of the need for repeated resection, particularly when the hepatic vein is difficult to dissect, this approach can be safe and useful, while providing an adequate postoperative liver mass in the short-term to recover uneventfully from major liver resection.

Keyword

Hepatectomy; Polycystic liver disease; Hepatic veins; Case reports

Figure

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  Fig. 1 Preoperative unenhanced abdominal computed tomography. Contrast was injected into the drained cyst in a previous study. (A, B) Axial views of segments 7 and 8; (C) large cyst in a small segment 4 with viable parenchyma in segments 5 and 6. (D) Digital reconstruction showing parenchyma in gray, liver cysts in orange, drain in white, and large, partially drained central cyst in pink.

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  Fig. 2 Surgical view of the liver before resection.

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  Fig. 3 Surgical view of the liver after resection. (A) After parenchymal transection; (B) after specimen removal.

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  Fig. 4 Unenhanced abdominal computed tomography 90 days after liver resection. (A) Small, asymptomatic right pleural effusion. (B, C) Partial atrophy of segments 5 and 6 with hypertrophy of the left lateral section. (D) Postoperative digital reconstruction of unenhanced computed tomography two and a half years after the operation, showing parenchyma in gray, and liver cysts in orange.

Reference

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