Third hepatectomy for recurrent colorectal liver metastasis and double reconstruction of the hepatic vein and vena cava with peritoneal patchs under total vascular occlusion

Abstract

Summary Background: In patients with colorectal liver metastases and good response to chemotherapy, liver resection associated with venous resection had benefits. With the improvements of surgical technique complicated resections can be done under short total vascular occlusion and the peritoneum is very useful for venous reconstruction Patients and methods: 78 years old female had recurrent colorectal liver metastasis treated 14 and 9 years ago by (colectomy and left lateral sectionectomy and wedge segment VI) and (segment VII associated with resection of the right hepatic vein), respectively. Actually she had recurrent lesion in segment VIII invading the only remnant middle hepatic vein and the vena cava. Very good response to chemotherapy. We decided segment VIII resection and venous reconstruction with the peritoneum under short total vascular occlusion. Results: The operative duration was 240 minutes, Blood loss (300 ml), Transfusion (2 units of blood), Intermittent clampage of the hepatic pedicle (30 mn), total vascular occlusion (36 mn). The postoperative outcome was uneventful and both venous reconstructions were patent on postoperative CT scan. The hospital stay was 21 days. Histology confirmed the diagnosis of colorectal metastasis, 3 cm, necrosis (70%), R0 resection and no histological invasion of the venous wall. One year late, she developed non local liver recurrence. Conclusion: As surgical techniques improve, complicated liver resection can be performed during short duration total vascular exclusion. The peritoneum is an excellent autogenous graft for venous reconstruction.