Double Mini Upper Transversal Hepatectomy for Colorectal Liver Metastases Infiltrating the Right and the Left Hepatic Veins at the Hepatocaval Confluence.
Felice Giuliante, Simone Famularo, Elena Panettieri et al.
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Case in brief
A 48-year-old woman with sigmoid colon cancer and bilateral liver metastases presented with tumors infiltrating both the right and left hepatic veins at the caval confluence. Following primary tumor resection and chemotherapy, imaging revealed peripheral communicating veins allowing for a parenchyma-sparing double mini upper transversal hepatectomy. The procedure successfully preserved the middle hepatic vein, ensuring adequate venous outflow, and the patient experienced no major complications, being discharged on postoperative day 12.
What made this case unusual
The case highlights the feasibility of resecting tumors traditionally deemed unresectable due to infiltration of both hepatic veins, utilizing peripheral communicating veins for venous drainage.
Diagnostic / clinical pearl
Clinicians should consider the presence of peripheral communicating veins when evaluating resectability of liver metastases involving major hepatic veins.
Why it matters
This case demonstrates an innovative surgical approach that can expand the options for patients with complex liver metastases, potentially improving outcomes in similar cases.