Tunnel hepatectomy: A review of the parenchymal-sparing technique in colorectal liver metastasis and operative video

Abstract

Introduction: Surgery of colorectal liver metastases (CRLM) has evolved over the past decades from an interest mainly focused on oncological margins to a new surgical policy known as parenchymal sparing hepatectomy (PSH). Contrary to anatomical resection (AR), this new approach combines the well-known issue of curative resections (R0 resections) in tumor removal with a new doctrine, reducing the unnecessary sacrifice of healthy parenchyma as much as possible (salvageability). Case Report: We report the case of a 60-year-old man diagnosed with rectal adenocarcinoma accompanied by seven synchronous bilobar liver metastases, including two closely situated metastases. The first was located in liver segment VIII, whereas the second was positioned between segments VIII and IV, just beneath the middle hepatic vein (MHV). In order to resect these two lesions without sacrificing the middle hepatic vein and preserving as much hepatic parenchyma as possible, we have chosen a conservative resection approach, the tunnel hepatectomy (TH). Conclusion: Parenchymal sparing hepatectomy is the recommended approach in CRLM disease. Beyond the need to ensure healthy oncological margins, every surgeon should pay special attention to preserving hepatic parenchyma. Therefore, 3D modeling of the liver and its lesions appear to be a great assistance before any sophisticated surgical intervention to ensure the most conservative surgery possible. And for patients with deep liver metastases having complex relationships, TH seems to be a suitable technique.