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Extended left hepatectomy

Ex vivo reconstruction of the right posterior portal vein, autologous liver transplant
 
 
Case description
  • A young woman presented with a metastatic colon cancer deposit in the left lobe of her liver.
  • The tumour had grown into and down the left portal vein, across the portal vein bifurcation, and into the anterior branch of the right portal vein, occluding all of these structures. Although the posterior branch of the right portal vein was occluded as well, the right posterior portal vein system was filled via multiple collaterals running in the biliary plate.
  • An ex vivo approach was taken to perform an extended left hepatectomy. The patient's vena cava was left intact and a temporary porto-caval shunt was performed to avoid veno-veno bypass. The right posterior portal vein collaterals were divided and controlled on the backbench.
  • The main portal vein was reconstituted using a superficial femoral vein graft. Segment 6/7 was then re-implanted, anastomosing the vein graft to the divided right posterior vein.
  • The patient was discharged home two weeks post-operatively and remains well at three months follow-up.
CT scans (venous phase)

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