Anatomical subsegmentectomy in the lateral segment for hepatocellular carcinoma

In this article, we describe a safe technique and the outcome of anatomical subsegmentectomies of segments 2 and 3 in patients with chronic liver disease. In cases of subsegmentectomy of segment 2, Arantius duct is transected at the side of umbilical portion and then the hver parenchyma located just above the root of the glissonean pedicle feeding segment 2 is transected. This procedure allows to encircle and dissect the root of the glissonean pedicle feeding segment 2 safely even in cirrhotic patients. After marking the discolored area on the liver surface, parenchymal transection between segment 2 and segment 3 was performed. In cases of subsegmentectomy of segment 3, the root of the glissonean pedicle feeding subsegment 3 is encircled and dissected from the ventral side of the umbilical portion before liver parenchymal resection. Using our technique, we performed subsegmentectomies of segment 3 in four hepatocellular carcinoma (HCC) patients and of segment 2 in two HCC patients. There was no postoperative liver failure and remnant liver function was adequate in all six of our cases. Although three of the six patients had HCC recurrence after hepatectomy, various and multiple treatments for HCC recurrence could be performed in these three patients. Subsegmentectomies for HCC located in the lateral segment were performed safely and could contribute to preservation of remnant liver function.