En Bloc Resection of a 60cm Recurrent Dedifferentiated Liposarcoma Involving the Liver, Right Kidney and Ascending Colon

Abstract

This case report was about a giant recurrent dedifferentiated liposarcoma which invaded the intraperitoneal space to the posterior sector of liver, attaching the right hepatic vein (RHV) and inferior vena cava (IVC). It had already encased the right kidney, right ureter, right colon and mesocolon. The whole IVC was compressed and pushed to the left side and ventral side of the abdominal space by this giant tumour. The posterior approach cannot be done due to the heavy giant tumour (about 28 Kg) and change of anatomy landmarks. By anterior approach to cut into the liver parenchyma, dissection and exposure along the surface of RHV can advance to the IVC surface. Small venous outflow tracts from the tumour to the surface of RHV and IVC were exposed, ligated and separated. After the junction of RHV and retrohepatic IVC was exposed, cranial to caudal dissection using an ultrasonic aspirator along the ventral, lateral and posterior surface of IVC can separate the IVC wall from the tumour clearly. Further dissection downward along the surface of the twisted IVC was useful to separate the tumour from the posterior side of pancreatic head, portal vein, superior mesentery vein (SMV), and the root of right renal vein. In conclusion, an anterior approach of hepatotomy for RHV first and then IVC is a useful method for this giant tumour if the posterior approach for IVC exposure cannot be done.