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Surg Radiol Anat (2010) 32:911917 DOI 10.1007/s00276-010-0643-3
ORIGINAL ARTICLE
RamiWcation of Glissons sheath peripheral branchesand clinical implications in the era of local ablation therapy
Jung Hun Lee Guang Yu Jin Zhe Wu Jin Hee Chul Yu Baik Hwan Cho
Received: 23 September 2009 / Accepted: 18 February 2010 / Published online: 4 March 2010 Springer-Verlag 2010
Abstract
Purpose Classical anatomical resection does not always guarantee tumor-free margins when the tumor overrides traditional anatomical planes. Surgeons and interventionists frequently need to focus on the peripheral branches of Glissons sheath in patients with poor hepatic reserves, particularly when the tumor is deep seated. The present study used anatomical liver dissection to investigate the spatial distribution of the branches of Glissons sheath in each of four liver sectors.
Methods Sixty-four adult human liver specimens were dissected. The size and ramiWcation patterns of Glissons sheath in each sector were analyzed in terms of bilateral homology within two paramedian sectors and within two lateral sectors.
Results Each liver sector had a characteristic Glissons sheath in terms of trunk shape and ramiWcation pattern. The two paramedian sectors showed point symmetry. Most of the branches of the two paramedian sectors emerged from the top of a short stout trunk. Although the two paramedian sectors were similar in terms of basic conWguration, the ramiWcation axes were almost perpendicular to each other. Unlike the paramedian sectors, the two lateral sectors showed not much homology.
Conclusions The peripheral branches of Glissons sheath were generally longer (approximately 5 cm) and thicker than anticipated. Extirpation strategies should take into account that each liver sector has a characteristic Glissons sheath ramiWcation pattern.
Keywords Small HCC RamiWcation pattern Branches of Glissons sheath Paramedian sectors Lateral sectors
Introduction
Pretreatment imaging modalities, such as ultrasound (US), computer tomography and magnetic resonance imaging can be used to determine the most appropriate treatment strategy for hepatocellular carcinoma (HCC) patients. Both tumor size and localization inXuence decisions regarding treatment modality. The extent of extirpation is aVected by the relationship between the tumor and regional anatomic structures, such as large vessels. However, classical anatomical resection does not always guarantee tumor-free margins when the tumor overrides traditional anatomical planes. Recent advances in imaging have facilitated early diagnosis of small tumors and allowed identiWcation of Wne...