Introduction. Reducing the volume of resected liver parenchyma may lead to lower morbidity and mortality. The aim of this study was to determine whether partial preservation of segment IV leads to improved outcomes when undertaking extended right hepatectomy for colorectal liver metastases (CRLM). Materials and Methods. A retrospective analysis of patients undergoing right-sided hepatectomy for CRLM was performed. Rates of 90-day mortality and organ dysfunction were compared in 117 patients undergoing right hepatectomy , partially extended right hepatectomy with preservation of part of segment IV , and fully extended right hepatectomy . Results. The 90-day mortality rate of those undergoing right hepatectomy (3/85) was similar to that of those undergoing extended right hepatectomy (0/12) but lower than that of those undergoing partially extended right hepatectomy (4/20) . The rates of hepatic and renal dysfunction were similar between patients undergoing right hepatectomy, partially extended or extended hepatectomy. Discussion. Preservation of part of segment IV confers little clinical benefit when performing extended right hepatectomy for CRLM. 1. Introduction Extended right hepatectomy is indicated for solitary tumours involving the midplane of the liver and for multifocal tumours involving both the right lobe of the liver and segment IV. The Brisbane classification defines an extended right hepatectomy as the removal of the right lobe of the liver plus all of segment IV up to the umbilical fissure [1]. This procedure removes the most functioning liver (5 or 6 segments) of all liver resections and exposes patients to a significant risk of posthepatectomy liver failure (PHLF), which is associated with a high mortality, especially when complicated by renal dysfunction [2]. The reported incidence of PHLF after extended right hepatectomy is between 1.2% and 32% in published series [3–10]. Lactic acid produced during anaerobic metabolism is cleared by the liver [11] and hyperlactataemia has been shown to predict postoperative liver dysfunction [12]. As the blood supply and biliary drainage of segment IV is provided via the umbilical fissure [13] it is often technically possible to preserve part of segment IV with an intact blood supply and biliary drainage when performing extended right hepatectomy. Although segment IV accounts for only 20% of total liver volume [14] this proportion more than doubles in a right hepatectomy when only segments I–IV remain. Therefore, preservation of part of segment IV may potentially increase the volume of functioning liver
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