Classification of right hepatectomy for special localized malignant tumor in right liver lobe.

Aim: To describe a new classification method of right hepatectomy according to the different special positions of tumors.

Methods: According to positions, 91 patients with malignant hepatic tumor in the right liver lobe were divided into six groups: tumors in the right posterior lobe and (or) the right caudate lobe compressing the right portal hilum (n = 14, 15.4%), tumors in the right liver lobe compressing the inferior vena cava and (or) hepatic veins (n = 11, 12.9%), tumors infiltrating diaphragmatic muscle (n = 7, 7.7%), tumors in the hepatorenal recess (infiltrating the right fatty renal capsule, transverse colon and right adrenal gland, n = 8, 8.8%), tumors deeply located near the vertebral body (n = 3, 3.3%), tumors at other sites in the right liver lobe (the control group, n = 48, 52.75%). The values of intraoperative blood loss (IBL), tumor's maxim cross-section area (TMCSA), and time of hepatic hilum clamping (THHC) and incidence of postoperative complications were compared between five groups of tumor and control group, respectively.

Results: The THHC in groups 1-4 was significantly longer than that in the control group, the IBL in groups 1-4 was significantly higher than that in the control group, the TMCSA in groups 2-4 was significantly larger than that in the control group, and the ratio of IBL/TMCSA in group 1 was significantly higher than that in the control group. There was no significant difference in the indexes between group 5 and the control group.

Conclusion: The site of tumor is the key factor that determines IBL.