Ann Hepatobiliary Pancreat Surg.  2024 Feb;28(1):109-113. 10.14701/ahbps.23-102.

Extended left hepatectomy associated with resection of the vena cava and suprahepatic veins by in situ perfusion to treat intrahepatic cholangiocarcinoma

• Nobre CCG
• Sampaio RL
• Ximenes ACM
• Coelho GR
• Garcia JHP

• KMID: 2553374
• DOI: http://doi.org/10.14701/ahbps.23-102

Abstract

Cholangiocarcinoma is a heterogeneous group of aggressive tumors that correspond to the second most common primary liver tumor. They can be classified according to their anatomical position concerning the biliary tree, and each subtype demonstrates different behavior and treatment. A 38-year-old male patient presenting solely right lumbar pain was diagnosed with a 7 cm hepatic tumor involving segments I, Iva, and VIII associated with involvement of the hepatic veins. He underwent a bloc resection of hepatic segments I, II, III, IV, partial V, partial VII, and VIII; right, middle, and left hepatic veins; and inferior vena cava segment, with perfusion of the remaining liver in situ with a preservation solution. As the patient had a large accessory inferior right hepatic vein draining the remaining liver, no reimplantation of hepatic veins was necessary. He remained clinically stable in outpatient follow-up, with excellent performance status—current survival of 2 years 6 months after surgical treatment.

Keyword

Cholangiocarcinoma; Intrahepatic cholangiocarcinoma; Hepatectomy; Hepatic veins

Figure

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  Fig. 1 Preoperative abdominal computed tomography showing a 7.0 cm sized liver tumor in segment VIII.

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  Fig. 2 Abdominal magnetic resonance imaging showing inferior right hepatic vein–Makuuchi vein (arrow) draining segments VI and VII into the inferior vena cava.

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  Fig. 3 Representation of surgical planning with the markings of liver resection (dashed), inferior hepatic vein (arrow), and final hepatectomy area–extended left hepatectomy (shaded).

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  Fig. 4 Surgical overview. (A) Liver after ligation of the left portal vein showing Cantlie’s line (dashed line) and hepatectomy limit marking (arrow). (B) Superior view of the surgical specimen with visualization of the vena cava segment resected en bloc (arrow).

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  Fig. 5 Reconstruction of the inferior vena cava segment with homologous graft after perfusion.

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