Encapsulation of Hepatic Progenitor Cells for Liver Tissue ...
Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow...
Transcript of Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow...
![Page 1: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/1.jpg)
Liver Anatomy (and HCC)
![Page 2: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/2.jpg)
External Anatomy
![Page 3: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/3.jpg)
Components of Hepatectomy
Left
RHV MHV LHV
Right
OutflowHepatic veinsVena Cava
InflowHepatic arteryPortal vein
Parenchyma
![Page 4: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/4.jpg)
Segmental Liver Anatomy
![Page 5: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/5.jpg)
Right liver Left liver
IV III
II
I
Left pedicleRight pedicle
Leftpedicle
VI
VVIII
VII
Portal Pedicles
![Page 6: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/6.jpg)
7
84 2
6
54 3
CT Segmental Anatomy
1
![Page 7: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/7.jpg)
?
![Page 8: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/8.jpg)
Caudate
![Page 9: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/9.jpg)
Components of Hepatectomy
Left
RHV MHV LHV
Right
OutflowHepatic veinsVena Cava
InflowHepatic arteryPortal vein
?Extrahepatic or intrahepatic control of inflow and outflow?
Parenchyma
![Page 10: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/10.jpg)
Hepatic veins
![Page 11: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/11.jpg)
Hepatic veins
![Page 12: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/12.jpg)
Hepatic veins
![Page 13: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/13.jpg)
Outflow Control
Extra-hepatic
Intra-hepatic
![Page 14: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/14.jpg)
Left Liver Mobilization
![Page 15: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/15.jpg)
LHV and MHV Control
![Page 16: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/16.jpg)
Right Liver Mobilization
![Page 17: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/17.jpg)
Outflow ControlRight Hepatic Vein Division
![Page 18: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/18.jpg)
Extrahepatic Outflow ControlImportance of the Middle Hepatic Vein
• No liver hypertrophy• Large loss of normal liver
![Page 19: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/19.jpg)
Extrahepatic Outflow Control
RHV
MHV LHV
IVC
![Page 20: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/20.jpg)
Extrahepatic Outflow Control
![Page 21: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/21.jpg)
Hepatic artery
![Page 22: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/22.jpg)
CT Angiogram
![Page 23: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/23.jpg)
Right liver Left liver
IV III
II
I
Left pedicleRight pedicle
Leftpedicle
VI
VVIII
VII
Inflow - Intrahepatic Pedicles
![Page 24: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/24.jpg)
Portal Pedicles
![Page 25: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/25.jpg)
Portal Pedicles
![Page 26: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/26.jpg)
Portal vein - left
![Page 27: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/27.jpg)
Main Pedicles
![Page 28: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/28.jpg)
Right Main Pedicle
![Page 29: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/29.jpg)
Hepatotomies for Inflow Control
For right pedicle control
![Page 30: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/30.jpg)
Inflow ControlRight Pedicle Division
![Page 31: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/31.jpg)
Intrahepatic Inflow Control
![Page 32: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/32.jpg)
Extrahepatic Inflow Dissection
• Time consuming
• Difficult if previous RUQ surgery
• Associated with vascular/biliary injury on occasion
• Mandatory for perihilar tumors
![Page 33: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/33.jpg)
Left Portal Vein
![Page 34: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/34.jpg)
Inflow/Outflow Control?Hepatocellular Carcinoma
![Page 35: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/35.jpg)
Anterior Sectorectomy
![Page 36: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/36.jpg)
![Page 37: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/37.jpg)
Colorectal metastases
Left Lateral Segment Right Posterior Sector
![Page 38: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/38.jpg)
Hepatocellular carcinoma
![Page 39: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/39.jpg)
HCC Features
DiagnosisCT/MR: Hypervascular on arterial phase with washoutAFP >500Biopsy
StagingLymph node involvementDistant disease
Treatment - Hepatic function, portal HTNResectionEmbolizationTransplant
![Page 40: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/40.jpg)
Cirrhosis
![Page 41: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/41.jpg)
“Hanging” Hepatoma
![Page 42: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/42.jpg)
40 y.o. F with acute RUQ pain
![Page 43: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/43.jpg)
Four patients with HCC
Portal vein
Tumor expanding portal vein
Tumor in posterior sectoralportal vein
Patient 2
Patient 1 Patient 3
Tumor in IVC andatrium
Tumor in middlehepatic vein
Tumor in lefthepatic vein
Patient 4
![Page 44: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/44.jpg)
39 y.o. Caucasian female without risk factors
![Page 45: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/45.jpg)
Sorafenib in Advanced HCC
NEJM 359:378-90, 2008
10.7 vs. 7.9 months
![Page 46: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/46.jpg)
65 y.o. drinker with pain, AFP 40
![Page 47: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/47.jpg)
10 year survivors HCC
Ann Surg Oncol 24:1358-66, 2017
![Page 48: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/48.jpg)
10 year survivors HCC
Ann Surg Oncol 24:1358-66, 2017
![Page 49: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/49.jpg)
50 y.o. Asian female with Hepatitis B
![Page 50: Liver Anatomy (and HCC)External Anatomy Components of Hepatectomy Left RHV MHV LHV Right Outflow Hepatic veins Vena Cava Inflow Hepatic artery Portal vein Parenchyma Segmental Liver](https://reader030.fdocuments.us/reader030/viewer/2022040904/5e780f399174782dd2224191/html5/thumbnails/50.jpg)
Liver tumor
Nodal met
Liver tumor
20 y.o. male with pain