Clinical experience with the intrahepatic posterior approach to the portal triad for right hepatectomy and right segmental resection.

Abstract

An intrahepatic posterior approach to the portal triad has been used over a 2-year period to perform right hepatectomies and right segmental resections in 29 patients (20 men, 9 women; median age 63 years, range 22-82 years). Two resections were palliative for cholangiocarcinomas; the remainder included 9 hepatocellular carcinomas, 12 colorectal metastases, 2 adenomas, 3 cancers of the gallbladder, and one case of chronic hepatic fibrosis. The median operative time was 3 hours 40 minutes (3:40; range 2:20-7:00) with a median period of hepatic ischemia of 87 minutes (range 27-152 minutes). Median blood transfused was 0 unit (range 0-12 units) with only three patients requiring intensive care admission. There was one hospital death. All but one patient was followed up after surgery (median period 24 months; range 1-36 months) at which time there had been three deaths from metastatic disease; the remaining patients were free of clinical recurrence. This operative approach allows minimally resective surgery to be performed safely with excellent short- and medium-term results.