Successful Redo Right Hepatic Vein Reconstruction for Recurrent Colorectal Liver Metastases After Triple Hepatic Vein Resection: Implications of Late-Onset Venous Stenosis.
Yui Sawa, Yoshihiro Ono, Gaku Shimane et al.
✦ AI-curated · Sources linked
Case in brief
A 49-year-old woman with initially unresectable rectal cancer and multiple liver metastases involving all three major hepatic veins underwent chemotherapy followed by extended hepatectomy with triple hepatic vein resection and reconstruction. Eight years later, imaging showed severe stenosis of the reconstructed right hepatic vein, without definitive evidence of recurrence. Redo resection and reconstruction using a right internal jugular vein graft were performed; pathology confirmed tumor recurrence. In the authors’ institutional review, all late-onset stenoses among reconstructed veins were associated with tumor recurrence, whereas technical stenoses occurred within 6 months.
What made this case unusual
The reconstructed right hepatic vein remained patent for 8 years before severe stenosis revealed recurrence that imaging had not definitively identified.
Diagnostic / clinical pearl
Late stenosis of a reconstructed hepatic vein should prompt suspicion of tumor recurrence, even when imaging is not definitive; pathology may establish the diagnosis.
Why it matters
Redo hepatic vein resection and reconstruction with a right internal jugular vein graft was feasible in this selected patient.