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

Susumu Eguchi,Shinichiro Ono,Akihiko Soyama,Saeko Fukui-Araki,Yuriko Isagawa-Takayama,Masaaki Hidaka,Tomohiko Adachi,Takashi Hamada,Yu Huang,Kengo Kanetaka,Mitsuhisa Takatsuki

doi:10.1016/j.ijscr.2019.03.004

Susumu Eguchi, Shinichiro Ono + Show 9 more

Open Access

https://doi.org/10.1016/j.ijscr.2019.03.004

Copy DOI

Abstract

IntroductionA malignant tumor invading the inferior vena cava (IVC) and concomitant with 3 hepatic venous involvement still remains surgical therapeutic challenge. Presentation of caseA 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. DiscussionThis technique could be one of the options to reconstruct the HV/IVC when a tumor invades all 3 HVs. ConclusionTo 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.

Highlights

A malignant tumor invading the inferior vena cava (IVC) and concomitant with 3 hepatic venous involvement still remains surgical therapeutic challenge
We describe the first case of intrahepatic cholangiocellular carcinoma (IHCCC) that had invaded the IVC and the right hepatic vein (RHV), which was successfully resected ex vivo and reconstructed with auto venous graft combining the ICV and the left renal vein (LRV)
A 79-year-old male presented with liver dysfunction and was eventually diagnosed with an intrahepatic huge IHCC originating at the level of the confluence of the 3 hepatic veins to the IVC, extending to the right hepatic vein (Fig. 1A–C)

Summary

INTRODUCTION

A malignant tumor invading the inferior vena cava (IVC) and concomitant with 3 hepatic venous involvement still remains surgical therapeutic challenge. The liver with the IVC, portal vein, hepatic artery and common bile duct were removed en bloc. 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. The patient’s right liver lobe with the reversed LRV/IVC graft was transplanted back into the patient using a partial liver transplant technique. 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

Introduction

Presentation of case

Discussion

Conclusion

Ethical approval