Complex resections for focal neoplasms of hepatico-caval confluence in children

Abstract

Aim. To analyze the results of liver resection for neoplasms of hepatico-caval confluence without hepatic vein reconstruction in children.Materials and methods. From June 2017 to April 2022, surgical treatment was performed in 5 patients with tumors in hepatico-caval confluence requiring resection of the right hepatic vein and/or median hepatic vein.Results. Two children underwent VII, VIII bisegmentectomy, one of them – laparoscopically. One child underwent laparoscopically assisted IVa, VIII subsegmentectomy. Two children underwent I, IVa, VIII trisegmentectomy with atypical SII, III resection, as well as IVa, VIII, VII trisegmentectomy with I segmentectomy. The median duration of5surgery was 445 min. (315–785), the median blood loss was 400 ml (150–3000). In the postoperative period, complications developed in 2 patients (IIIa and IIIb according to Clavien-Dindo classification), no disturbance of venous outflow from the lower segments of the liver was detected. Vascular margin of R1 resection was obtained in case 1.Conclusion. In the majority of cases of hepatico-caval confluence tumors in children, liver resection, when carefully planned, does not require prosthetics of the right hepatic vein and/or middle hepatic vein and is not accompanied by venous outflow disturbance from the lower liver segments by means of the collaterals to the preserved hepatic veins.