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| Complete resection of the hepatic veins: The role of right inferior vein |
| Emanuele Felli∗, Roberto L. Meniconi, Marco Colasanti, Giovanni Vennarecci, Giuseppe M. Ettorre |
Division of General Surgery and Liver Transplantation, San Camillo Hospital, Circ.ne Gianicolense 87, Rome 00152, Italy
∗Corresponding author.
E-mail address: efelli@scamilloforlanini.rm.it (E. Felli) |
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Abstract To the editor:
In the recent years liver surgery has been dramatically improved because of technical and technological innovations, perioperative and intraoperative intensive care, better knowledge of liver physiology and early recognition and treatment of postoperative complications. Last but not least, liver anatomy, though not so recent in its topographic organ description, is still a cornerstone of surgical strategy today [1,2]. It is important to consider the future liver remnant volume, blood inflow and outflow before the major liver resection. Insufficient drainage of vascularized liver parenchyma may lead to postoperative liver congestion, transection surface bleeding and hepatic failure. Hepatic veins drain the majority of liver outflow, with the exception of the spigelian veins and the accessory right veins, which are variables in number and caliber, that drain directly into the inferior vena cava. An accessory right inferior vein can be of great importance in case of large bilobar primary or secondary liver tumors to achieve R0 resection and adequate venous drainage. The incidence of an inferior right hepatic vein is reported in 9%−28% of patients according to anatomical studies [3], with variable dimension and hemodynamic importance. Baer et al. [4] reported in 1991 the first case of subtotal hepatectomy with resection of the three hepatic veins in a patient with an accessory right inferior vein. In the preoperative evaluation of hepatic surgery, adequate future liver remnant has to be considered, together with adequate arterial and portal inflow, venous outflow and biliary drainage. For large bilobar tumors involving the three hepatic veins, resection is possible if a right accessory inferior hepatic vein is present, or if the hepatic vein can be reconstructed.
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2018, Vol. 17 
