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Annals of Surgical Oncology

, Volume 21, Issue 8, pp 2699–2699 | Cite as

Conservative Hepatectomy for Tumors Involving the Middle Hepatic Vein and Segment 1: The Liver Tunnel

  • Guido TorzilliEmail author
  • Matteo Cimino
  • Fabio Procopio
  • Guido Costa
  • Matteo Donadon
  • Daniele Del Fabbro
  • Andrea Gatti
  • Carlos A. Garcia-Etienne
Hepatobiliary Tumors

Abstract

Background

For lesions invading the middle hepatic vein (MHV) at caval confluence (CC) the mini-mesohepatectomy(MMH) was proposed.1 If the lesion is extended to the paracaval portion of segment 1(S1) in contact or invading the MHV a new procedure is proposed.

Methods

Case-1: mass forming cholangiocarcinoma (MFCCC) 4cm in size invading the MHV and in contact with right (RHV) and left hepatic vein (LHV) at the CC. In Case-2, two colorectal liver metastases (CLM) both 2cm in size occupied S1 (T1) and S8 (T2): T1 was located between RHV and the inferior vena cava (IVC), T2 was in contact with MHV at CC. According to tumor-vessel intraoperative-ultrasound classification2 and color-flow analysis3 parenchyma-sparing procedure was performed.

Results

In Case-1 a communicating vein (CV) between RHV and MHV was detected at color-flow-IOUS. Contacts between MFCCC with RHV and LHV were confirmed at IOUS as detachable. In Case-2 contact between T1 with MHV was confirmed at IOUS as detachable. Liver-tunnel with IVC and main portal vein bifurcation exposure was performed resecting the MHV in Case-1 and preserving it in Case-2. Both patients had ad an uneventful postoperative course and were discharged on the 8th postoperative day.

Conclusion

For tumors involving S1, S4s and/or S8 and infiltrating or in contact with the MHV at the CC, can be removed in a conservative manner by means of the herein described ‘‘Liver Tunnel’’ approach. The latter introduces a further step in favour of parenchyma-sparing policy for centrally located lesions with complex tumor-vessel relationship.

Keywords

Oncol Electronic Supplementary Material Inferior Vena Cava Conservative Manner Hepatic Vein 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Supplementary material 1 (MPG 76602 kb)

References

  1. 1.
    Torzilli G, Botea F, Donadon M, et al. Minimesohepatectomy for colorectal liver metastasis invading the middle hepatic vein at the hepatocaval confluence. Ann Surg Oncol. 2010;17:483.PubMedCrossRefGoogle Scholar
  2. 2.
    Torzilli G, Montorsi M, Del Fabbro D, et al. Ultrasonographically guided surgical approach to liver tumours involving the hepatic veins close to the caval confluence. Br J Surg. 2006;93:1238–46.PubMedCrossRefGoogle Scholar
  3. 3.
    Torzilli G, Garancini M, Donadon M, et al. Intraoperative ultrasonographic detection of communicating veins between adjacent hepatic veins during hepatectomy for tumours at the hepatocaval confluence. Br J Surg. 2010;97:1867–73.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Guido Torzilli
    • 1
    Email author
  • Matteo Cimino
    • 1
  • Fabio Procopio
    • 1
  • Guido Costa
    • 1
  • Matteo Donadon
    • 1
  • Daniele Del Fabbro
    • 1
  • Andrea Gatti
    • 1
  • Carlos A. Garcia-Etienne
    • 1
  1. 1.Department of Hepatobiliary Surgery, Humanitas Research HospitalUniversity of Milan-School of MedicineRozzanoItaly

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