EUS dating with laser ablation against the caudate lobe or left liver tumors: a win-win proposition?

A 44-year-old man with hepatitis C virus-related cirrhosis underwent LDLT. The donor was his identical twin elder brother. On computed tomography, the markedly dilated umbilical vein was observed as a hepatofugal collateral. An extended left liver graft with the caudate lobe was harvested in a conventional manner. One orifice outflow reconstruction was performed by using an umbilical vein which was extracted from the recipient. This vein-flap sheet was sutured to the outflow orifice of the liver graft in a two-thirds circle on the ventral side. One wide outflow orifice with a 90-mm vein umbilical-vein flap on the ventral wall of outflow was created. Excellent triphasic waveforms and velocities were demonstrated on postoperative Doppler ultrasonography. The post-transplant course was uneventful, with no need for immunosuppressants, and the patient was discharged without any complications on postoperative day 27. The volume of left liver increased from 406 cm3 to 1,372 cm3 during the first 6 weeks after transplantation.

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Extended Right Hepatectomy with Total Caudate Lobe Resection and Biliary Tree Resection for a Large Colorectal Liver Metastasis Involving both the Right and Left Hepatic Lobes and the Umbilical Fissure: A Case Report

The American Surgeon ◽

10.1177/000313480507100517 ◽

2005 ◽

Vol 71 (5) ◽

pp. 447-449 ◽

Cited By ~ 1

Author(s):

Aljamir D. Chedid ◽

Marcio F. Chedid ◽

Cleber R.P. Kruel ◽

FÁbio M. Girardi ◽

Cleber D.P. Kruel

Keyword(s):

Colorectal Cancer ◽

Bile Duct ◽

Liver Metastasis ◽

Liver Tumors ◽

Hepatic Duct ◽

Early Death ◽

Caudate Lobe ◽

Right Hepatectomy ◽

Left Hepatic Duct ◽

Extended Right Hepatectomy

Very large right-sided liver tumors may grow up to the base of the umbilical fissure and involve the left hepatic duct and can occasionally reach the bile duct confluence. This kind of involvement has often been considered a contraindication to resection. We report a patient who presented with a large hepatic metastasis from colorectal cancer that reached the umbilical fissure and involved the left hepatic duct just above the bile duct confluence. An extended right hepatectomy including complete resection of caudate lobe was performed. We resected the left and common hepatic ducts, as well as both the entire hepatic and the proximal third of common bile duct. A long jejunal limb Roux-en-Y (45 cm) single-layer left intrahepatic hepaticojejunostomy was constructed. She is still well 14 months postoperatively. To the best of our knowledge, this is the first report of such a procedure employed for the treatment of a liver metastasis from colorectal cancer. Extended right hepatectomy including complete caudate lobe resection can be feasible even when the majority of the extrahepatic biliary system needs to be resected. Our approach probably offers the only chance to prevent early death from liver failure in these patients.

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