Hepatic Vein-Sparing Hepatectomy for Multiple Colorectal Liver Metastases at the Caval Confluence
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- 作者：Guido Torzilli MD ; PhD ; FACS (1)
Fabio Procopio MD (1)
Matteo Cimino MD (1)
Matteo Donadon MD (1)
Daniele Del Fabbro MD (1)
Guido Costa MD (1)
Carlos A. Garcia-Etienne MD (1)
1. Department of Hepatobiliary and General Surgery ; Humanitas Research Hospital ; University of Milan-School of Medicine ; Rozzano ; MI ; Italy - 刊名：Annals of Surgical Oncology
- 出版年：2015
- 出版时间：May 2015
- 年：2015
- 卷：22
- 期：5
- 页码：1576
- 全文大小：123 KB
- 参考文献：1. Schnitzbauer, AA, Lang, SA, Goessmann, H (2012) Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg. 255: pp. 405-414 97/SLA.0b013e31824856f5" target="_blank" title="It opens in new window">CrossRef
2. Jaeck, D, Oussoultzoglou, E, Rosso, E (2004) A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg. 240: pp. 1037-1049 97/01.sla.0000145965.86383.89" target="_blank" title="It opens in new window">CrossRef
3. Torzilli, G, Palmisano, A, Procopio, F (2010) A new systematic small for size resection for liver tumors invading the middle hepatic vein at its caval confluence: mini-mesohepatectomy. Ann Surg. 251: pp. 33-39 97/SLA.0b013e3181b61db9" target="_blank" title="It opens in new window">CrossRef
4. Torzilli, G, Donadon, M, Marconi, M (2008) Systematic extended right posterior sectionectomy: a safe and effective alternative to right hepatectomy. Ann Surg. 247: pp. 603-611 97/SLA.0b013e31816387d7" target="_blank" title="It opens in new window">CrossRef - 刊物主题：Surgical Oncology; Oncology; Surgery;
- 出版者：Springer US
- ISSN：1534-4681
文摘
Background Two-stage hepatectomies generally are selected for patients with multiple bilobar colorectal liver metastases (CLMs) involving the hepatic veins (HV) at the caval confluence to reduce the risk of postoperative hepatic failure due to insufficient remnant liver.1 , 2 The use of IOUS based on well-established criteria offers alternative technical solutions to the staged resections.3 , 4 This report describes a sophisticated IOUS-guided parenchyma-sparing procedure. Methods A 57-year-old woman with multiple CLMs underwent surgery. One of these CLMs was located in segments 8 to 4 sup involving the middle hepatic vein (MHV) at the caval confluence. A second CLM was between dorsal segment 8 and the paracaval portion of segment 1 involving the right hepatic vein (RHV) at the caval confluence. Neither the inferior RHV nor the communicating veins were evident at preoperative imaging. The left hemiliver represented 27 % of the total liver volume, and segments 2 and 3 represented 16 %. Results After a J-shaped thoracophrenolaparotomy, liver exploration with IOUS showed tumoral invasion of MHV and RHV at their caval confluence for one third of their circumference. No communicating veins were intraoperatively evident. A partial resection of segments 7, 8, and 4 superior and 1-paracaval sparing both RHV and MHV was performed. The latter were partially resected, and vessel wall reconstruction was obtained by direct running suture. No congested area or vascular thrombosis occurred, and the postoperative course was uneventful. No local recurrence had occurred after 6 months of follow-up evaluation. Conclusions The video shows an HV-sparing IOUS-guided hepatectomy as an alternative to conventional staged surgery. This policy represents a safe and effective alternative to major resection performed immediately or in a staged perspective.