Study of the Portal Branches Arising from the Cranial Part of the Umbilical Portion of the Left Portal Vein: Implication
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ORIGINAL SCIENTIFIC REPORT
Study of the Portal Branches Arising from the Cranial Part of the Umbilical Portion of the Left Portal Vein: Implications for Anatomic Right Hepatic Trisectionectomy Takayuki Minami1 • Tomoki Ebata1 • Yukihiro Yokoyama1 • Tsuyoshi Igami1 • Takashi Mizuno1 Junpei Yamaguchi1 • Shunsuke Onoe1 • Nobuyuki Watanabe1 • Masato Nagino1
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Accepted: 16 August 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background In ‘‘anatomic’’ right hepatic trisectionectomy for advanced perihilar cholangiocarcinoma, the left hepatic duct is divided at the left side of the umbilical portion (UP) of the left portal vein (LPV). For this reason, the left hepatic duct is completely detached from the UP after all division of the portal branches arising cranially from the UP. However, little is known about these thin portal branches. Methods Using 3D imaging processing software, we examined the portal branches arising cranially from the UP of the LPV in 100 patients who underwent multidetector row computed tomography (MDCT). Special attention was paid to the portal branch running to the left lateral sector, designated as the left cranio-lateral branch. Results The left cranio-lateral portal branch number was 0 in 57 patients, 1 in 32 patients, and 2 in 11 patients. Thus, 54 left cranio-lateral branches were identified, arising from near the cul-de-sac of the UP, from near the elbow of the LPV, or from the UP trunk. The median volume of the territory supplied by the left cranio-lateral portal branch was 21 mL (range, 5–47 mL), and the median ratio to the left lateral sector was 11.8% (range, 1.7–25.0%). Conclusion Approximately 40% of patients had the left cranio-lateral portal branches arising cranially from the UP and running to the left lateral sector. When planning anatomic right hepatic trisectionectomy, the presence or absence of this branch should be checked by using 3D imaging with MDCT.
Introduction Right hepatic trisectionectomy with caudate lobectomy, i.e., resection of Couinaud’s hepatic segments 1 and 4–8, is usually performed for advanced perihilar cholangiocarcinoma [1], which involves mainly the right intrahepatic bile ducts in continuity with segment IV bile duct. In this procedure, the left hepatic duct is conventionally divided at the ‘‘right’’ side of the umbilical portion (UP) of the left portal vein (LPV) [2, 3]. However, this division of the left & Masato Nagino [email protected] 1
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
hepatic duct can be achieved by right hemihepatectomy and is often associated with a positive proximal ductal margin [3]. To achieve R0 resection, one of our group developed an ‘‘anatomic’’ right hepatic trisectionectomy, in which the left hepatic duct is divided at the ‘‘left’’ side of the UP of the LPV (Fig. 1) [4]. With this approach, the left hepatic duct must be completely detached from the UP after all of the portal branches arising crani
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