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A 62-year-old man underwent right hepatectomy with resection of the middle hepatic vein trunk for metastatic liver cancers. Serious congestion of the caudal area of segment 4 occurred just after dividing the middle hepatic vein trunk. The reconstruction of the venous tributary from the caudal area of segment 4 to the inferior vena cava was performed using a saphenous vein graft of 11 cm in length. The congestion of the corresponding area improved just after the accomplishment of reconstruction, and the patient's postoperative course was uneventful. Serious congestion of the remnant liver observed in this case would occur rarely in the usual setting, because the stagnant blood flows backward to the portal branches or the intrahepatic venous anastomoses. In this case, the middle hepatic artery had been occluded by a steel coil for the treatment. Consequently, the occlusion of the middle hepatic artery have resulted in the serious congestion, because the portal branches to the caudal area of segment 4 were inflow vessels, not outflow ones, after division of the middle hepatic vein trunk. This is the first report on serious congestion of the caudal area of segment 4 and reconstruction of the venous tributary.

Background: The purpose of the study was to compare the abilities of the JIS and modified JIS (m-JIS) scores to predict survival after hepatectomy for hepatocellular carcinoma (HCC)., Methods: Data for patients who underwent hepatectomy for HCC at Hiroshima University Hospital between 1986 and 2006 were included. The overall survival and disease-free survival were calculated by the Kaplan-Meier method, and differences between groups were tested by the log-rank test. The statistics of the Akaike information criterion (AIC) were used to show the more appropriate model., Results: A total of 626 patients were included (male/female, 468/158; mean age, 63.4+/-9.6 years; Child-Pugh class A/B, 524/102; liver damage grade A/B/C, 356/261/9). Mean survival and disease-free survival were 8.04+/-0.39 and 4.69+/-0.32 years, respectively. There was a significant difference in the overall survival rate between JIS scores 1 and 2, and 2 and 3 (P<0.05), but not between scores 0 and 1, or 3 and 4 (P>0.05). Except between m-JIS scores 0 and 1, there was excellent discriminatory ability in overall survival rate between other consecutive groups. Concerning disease-free survival, a significant difference was found only between JIS scores 1 and 2. However, the disease-free survival rate could be well differentiated between m-JIS scores 1 and 2, and 3 and 4. The m-JIS score had a higher discriminatory ability, indicated by a linear trend analysis, and a higher homogeneity likelihood ratio, and lower AIC statistics, than the original JIS score in predicting both overall and disease-free survival., Conclusions: The modified-JIS scoring system using liver damage grade is better than the original JIS scoring system in predicting survival after hepatectomy for HCC in Japan.