1. Liver Resection Under Total Hepatic Vascular Exclusion with In Situ Hypothermic Isolated Hepatic Perfusion for Advanced Liver Tumors.
- Author
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Sadamori H, Monden K, Hioki M, Iwasaki H, Asami S, Nanba Y, and Takakura N
- Subjects
- Humans, Male, Colorectal Neoplasms pathology, Colorectal Neoplasms surgery, Middle Aged, Chemotherapy, Cancer, Regional Perfusion methods, Female, Aged, Prognosis, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Liver Neoplasms secondary, Liver Neoplasms surgery, Liver Neoplasms drug therapy, Hepatectomy methods, Carcinoma, Hepatocellular surgery, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular secondary, Carcinoma, Hepatocellular drug therapy, Vena Cava, Inferior surgery, Vena Cava, Inferior pathology, Hepatic Veins surgery, Hepatic Veins pathology, Hypothermia, Induced methods
- Abstract
Purpose: Continuous dissection or simultaneous reconstruction of the hepatic vein (HV) and inferior vena cava (IVC) was achieved under total hepatic vascular exclusion (THVE) with in situ hypothermic isolated hepatic perfusion (HIHP) in two cases. CASE 1: The patient previously underwent liver resections with the right HV for colorectal liver metastasis (CRLM). This time, the CRLM had invaded the left HV and IVC, and five courses of FOLFILI plus ramucirumab were given, resulting in stable disease. Due to expected high HV pressure, liver parenchymal transection was started under THVE. Sub-segmentectomy with patch graft plasty of the IVC and reconstruction of the left HV using a jugular vein graft were performed under THVE and HIHP. This patient died at home 3 months after surgery; the cause of death was unknown. CASE 2: Hepatocellular carcinoma in the caudate lobe was in extensive contact with the roots of three main HVs and the IVC, and pressed the hepatocaval confluence, with high HV pressure expected. In addition, tumor thrombosis extended to both the main portal vein and the common bile duct, resulting in the inability to introduce chemotherapy. After tumor thrombectomy, liver parenchymal transection was started under THVE. Extended left hepatectomy with wedge resection, and primary suture of the right HV and IVC was performed under THVE and HIHP. Recurrence-free and overall survivals were 8 months (lung metastasis) and 31 months, respectively., Conclusions: In liver resection for liver tumors located in the hepatocaval confluence, THVE with HIHP is useful for ensuring the safety., (© 2024. Society of Surgical Oncology.)
- Published
- 2024
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