J Liver Cancer.  2023 Mar;23(1):202-205. 10.17998/jlc.2023.01.27.

Parenchymal-sparing hepatectomy for multiple bilobar colorectal liver metastases in a Jehovah’s witness: a case report

• Ratnayake S
• Subasinghe D
• Dassanayake V
• Sivaganesh S

• KMID: 2540832
• DOI: http://doi.org/10.17998/jlc.2023.01.27

Abstract

Parenchymal-sparing hepatectomy (PSH), though technically challenging, is emerging as a choice of treatment for colorectal liver metastases (CRLM). PSH in Jehovah’s witness (JW) patients, for whom transfusion is not an option, involves complex surgical and medicolegal issues. A 52-year-old JW male with synchronous, multiple, bilobar liver metastases from a rectal adenocarcinoma was referred following neoadjuvant chemotherapy. At surgery, 10 metastatic deposits were observed and confirmed by intraoperative ultrasonography. Parenchymal-sparing non-anatomical resections were performed using a cavitron ultrasonic aspirator with the application of intermittent Pringle maneuvres. Histology confirmed multiple CRLMs with tumor-free resection margins. PSH is increasingly employed for CRLMs to preserve residual liver volume and minimize morbidity without compromising oncological outcomes. It is technically challenging, especially in the presence of bilobar, multi-segmental disease. This case illustrates the feasibility of performing complex hepatic surgery in special patient groups by meticulous planning and preparation involving multiple specialties and the patient.

Keyword

Parenchymal-sparing hepatectomy; Jehovah’s witnesses; Colorectal liver metastases

Figure

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  Figure 1. Pre-neoadjuvant (top row) and corresponding post-neoadjuvant (bottom row) computed tomography images taken at 70s post IV contrast demonstrating reduction in number and size of the liver.

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  Figure 2. Intraoperative images before and after resection of liver metastases.

Reference

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