Introduction : Preserving maximal future liver remnant is one of most important goals to be achieved in liver resection. When tumor is located between segment 7 and 8, it is hard to decide optimal extent of resection. This study aimed to evaluate the feasibility and safety of bisegmentectomy 7-8 with thick inferior right hepatic vein (IRHV) or with right hepatic vein (RHV) reconstruction.

Methods : Twenty Patients undergoing bisegmentectomy 7-8 between 2010 and 2017 were eligible for the study. Perioperative profile and surgical outcomes of these patients were compared with 22 patients undergoing right posterior sectionectomy (RPS) that is the resection of similar volume with bisegmentectomy 7-8 without hepatic vein resection. In the bisegmentectomy 7-8 group, 14 patients with obvious IRHV (median 6 mm, range 3.6–8.8 mm) underwent bisegmentectomy 7-8 without hepatic vein reconstruction. On the other hand, RHV reconstruction was performed for 6 patients who had no IRHV to retain venous outflow of remnant liver.

Results : Liver cirrhosis was more frequent in the bisegmentectomy 7-8 group than RPS group (55.0% vs. 18.2%, p=0.023). Baseline characteristics, besides liver cirrhosis, did not differ between the groups. Two patients undergoing RHV reconstruction experienced anastomosis obstruction in early postoperative period and eventually metallic stent was inserted. They recovered without sequellae. No differences in surgical characteristics and outcomes were observed between the two groups.

Conclusions : Bisegmentectomy 7-8 can be performed safely in selected patients who had thick IRHV. If there is no obvious IRHV, alternatively, RHV reconstruction can be considerable to preserve maximal future liver remnant.