# Segment IVb and V liver resection (versus wedge resection)

Source: https://onco.cc/terms/segment-ivb-v-resection/  
OnCo record `segment-ivb-v-resection` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Two ways of removing the piece of liver the gallbladder sits on during a gallbladder cancer operation: a wedge of about two centimetres around the gallbladder bed, or the whole of the two anatomical liver segments (IVb and V) that touch it. The larger operation clears more tissue but carries more complications, and the evidence does not clearly favour either.

## Summary

The gallbladder lies in a fossa between Couinaud segments IVb and V, and hepatic-side (T2b) tumours drain and spread into them. Radical cholecystectomy therefore removes either a non-anatomical wedge of liver around the fossa or the two segments in full. A 2023 systematic review of nine studies and 2,086 T2 patients (627 segmental, 1,459 wedge) found one-year disease-free survival higher after segmental resection (risk ratio 1.07) but no difference at three or five years, three-year overall survival lower after segmental resection (risk ratio 0.90; hazard ratio for death 1.33), more postoperative complications (risk ratio 1.90) and no difference in intrahepatic recurrence, and concluded the choice should weigh the patient's condition and the surgeon's experience (Chen 2023). The T2 side matters: T2b tumours have more vascular and neural invasion and nodal spread, and liver resection appears to improve survival in T2b in the 2022 meta-analysis of 2,531 patients (Shindoh 2015; Alrawashdeh 2022).

## Fields

- Kind: Term
- Last checked: 2026-09-24
- Also known as: Segment 4b/5 resection; Bisegmentectomy IVb and V; Gallbladder bed resection; Wedge resection of the gallbladder bed
- Tags: gallbladder; biliary

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Liver_segment
- Chen, Front Oncol 2023: wedge resection versus segment IVb and V resection for T2, meta-analysis: https://doi.org/10.3389/fonc.2023.1186378
- Alrawashdeh, HPB 2022: meta-analysis of T2a and T2b gallbladder cancer: https://doi.org/10.1016/j.hpb.2021.12.019
- Shindoh, Ann Surg 2015: tumour location in T2 gallbladder cancer (hepatic versus peritoneal side): https://doi.org/10.1097/sla.0000000000000728
- AHPBA expert consensus statement on gallbladder cancer (Aloia, HPB 2015): https://doi.org/10.1111/hpb.12444

## Connected records

- cancers: [Gallbladder adenocarcinoma](https://onco.cc/cancers/gallbladder-adenocarcinoma/), [Gallbladder cancer](https://onco.cc/cancers/gallbladder/), [Incidental gallbladder cancer (found after cholecystectomy)](https://onco.cc/cancers/incidental-gallbladder-cancer/)
- terms: [Hepatectomy (liver resection)](https://onco.cc/terms/hepatectomy/), [Radical (extended) cholecystectomy](https://onco.cc/terms/radical-cholecystectomy/), [T2a versus T2b gallbladder cancer (peritoneal side versus hepatic side)](https://onco.cc/terms/t2a-versus-t2b/)
- technologies: [Surgery for gallbladder cancer: simple versus radical cholecystectomy, re-resection and lymphadenectomy](https://onco.cc/technologies/gallbladder-cancer-surgery/)

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