Significance of Hepatic Vein Reconstruction in Hepatectomy for Hepatic Metastases of Colorectal Cancer

Satoshi Nakamura, Shohachi Suzuki, Takanori Sakaguchi, Atsushi Serizawa, Hiroyuki Konno, Shozo Baba

Second Department of Surgery, Hamamatsu University School of Medicine

When a metastatic tumor is near the confluence of the hepatic vein and inferior vena cava, the hepatic vein should be resected with the tumor. Seven patients with hepatic metastases of colorectal cancer underwent hepatectomy combined with hepatic vein reconstruction (HVR). Hepatectomy comprised the resection of segment 7 + 8 in 3 cases, segment 2 in 2, segments 7 + 8, and the upper portion of segment 4 in 1, and segment 5 + 6 + 8 and upper portion of segment 4 in 1. Right HVR was performed 4 in cases, middle in 1, and left in 2. Direct anastomosis without vein graft was carried out in 3 cases of right HVR. Hepatic venography, computed tomography, and hepatic scintigraphy were performed one month after surgery. There were no cases of mortality or in-hospital death. All 7 cases showed invasion of the tumor into the adventitia of the resected hepatic vein. The right hepatic vein was patent in all 4 cases, but 3 cases with middle or left hepatic vein graft had graft obstruction due to unsuitable selection of graft and infection at the liver stump. Two of the 3 cases with an obstructed graft had increased levels of glutamyl oxaloacetic transaminase at 2 to 3 weeks after operation. Hepatic scintigram with ^99m-Technetium phytate revealed decreased hepatic function in the area of an obstructed graft. Hepatic vein reconstruction in extended hepatectomy for hepatic metastases may be a useful option to preserve the function of the remnant liver.

Key words
metastatic liver tumor, colorectal carcinoma, hepatic vein reconstruction, hepatectomy

Reprint requests
Satoshi Nakamura Second Department of Surgery, Hamamatsu University School of Medicine
3600 Handa-cho, Hamamatsu-city, 431-31 JAPAN

Accepted
June 14, 1995

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