Extended right trisegmentectomy using in situ hypothermic perfusion with modified HTK solution for a large intrahepatic cholangiocarcinoma

One-step reconstruction of IVC and right hepatic vein using reversed auto IVC and left renal vein graft

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The left liver lobe was resected including the tumor and IVC ex vivo, and the right hepatic vein were reconstructed using the reversed patient’s left renal vein (LRV) and IVC graft.

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The patient’s right liver lobe with the reversed LRV/IVC graft was transplanted back into the patient using a partial liver transplant technique.

Introduction

A malignant tumor invading the inferior vena cava (IVC) and concomitant with 3 hepatic venous involvement still remains surgical therapeutic challenge.

Presentation of case

A 79-year-old male presented with liver dysfunction and was eventually diagnosed with an intrahepatic huge IHCC originating at the level of confluence of 3 hepatic veins to the IVC, extending to the right hepatic vein (HV). Under extracorporeal circulation, the liver with the IVC, portal vein, hepatic artery and common bile duct were removed en bloc. In the back table, the left liver lobe was resected including the tumor and IVC, and the right HV was reconstructed using the patient’s reversed left renal vein (LRV) and IVC graft. Subsequently, the patient’s right liver lobe with the reversed LRV/IVC graft was transplanted back into the patient using a partial liver transplant technique. Liver enzymes gradually came down to the value within normal range on postoperative day 13 with the patency of the right HV. However, the patient expired on POD 16 because of sudden septic complications.

Discussion

This technique could be one of the options to reconstruct the HV/IVC when a tumor invades all 3 HVs.

Conclusion

To the best of our knowledge, this is the first report of such HV reconstruction in combination with extracorporeal resection of huge liver cancer in updated world literature.