Sadamori Hiroshi, Monden Kazuteru, Hioki Masayoshi, Iwasaki Toshimitsu, Asami Shinya, Nanba Yasuo, Takakura Norihisa
Department of Surgery, Fukuyama City Hospital, Fukuyama, Japan.
Department of Surgery, Kousei General Hospital, Mihara, Japan.
Ann Surg Oncol. 2024 Sep;31(9):5638-5639. doi: 10.1245/s10434-024-15433-3. Epub 2024 May 20.
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.
In liver resection for liver tumors located in the hepatocaval confluence, THVE with HIHP is useful for ensuring the safety.
在两例患者中，通过全肝血管阻断（THVE）联合原位低温离体肝灌注（HIHP）实现了肝静脉（HV）和下腔静脉（IVC）的连续解剖或同时重建。病例1：该患者此前因结直肠癌肝转移（CRLM）接受了右肝静脉肝切除术。此次，CRLM侵犯了左肝静脉和下腔静脉，并接受了五个疗程的FOLFILI加雷莫西尤单抗治疗，病情稳定。由于预计肝静脉压力较高，在全肝血管阻断下开始肝实质离断。在全肝血管阻断和原位低温离体肝灌注下，进行了下腔静脉补片移植修补的亚段切除术，并使用颈静脉移植物重建左肝静脉。该患者术后3个月在家中死亡；死因不明。病例2：尾状叶肝细胞癌与三条主要肝静脉根部及下腔静脉广泛粘连，并压迫肝腔静脉汇合处，预计肝静脉压力较高。此外，肿瘤血栓延伸至门静脉主干和胆总管，导致无法进行化疗。肿瘤血栓切除术后，在全肝血管阻断下开始肝实质离断。在全肝血管阻断和原位低温离体肝灌注下，进行了扩大左肝切除术加楔形切除术，以及右肝静脉和下腔静脉的一期缝合。无复发生存期和总生存期分别为8个月（肺转移）和31个月。
对于位于肝腔静脉汇合处的肝肿瘤进行肝切除时，全肝血管阻断联合原位低温离体肝灌注有助于确保手术安全。
