Simultaneous S₃ Excision+Extended Right Hepatectomy and Low Anterior Resection for Rectal cancer with Murtiple Liver Metastases (H₃) -A Report of a Case-

Murato Miura, Masashi Ishikawa, Kenji Sasaki, Shinji Taki, You Fukuda, Hidenori Miyake, Yoshiyasu Terashima, Daisuke Wada, Shirou Yogita, Seiki Tashiro

The First Department of Surgery, The University of Tokushima School of Medicine

A 33-year-old woman was admitted to our hospital because of rectal cancer with multiple liver metastases (H₃). Almost the whole liver was occupied by multiple huge metastatic tumors except for the segments 1,2,4 (part) and 6 (part). The hepatic volume was calculated by computer imaging. The remnant hepatic volume (segment 1,2,4 [part]) was estimated to be 337 ml after right extended hepatectomy. This volume was thought to be enough for this patient because it was greater than half of the total normal liver and than the minimal essential liver volume of this patient. Based on this estimation, simultaneous S₃ excision+extended right hepatectomy and low anterior resection with lymph node dissection (D₂) were carried out with no difficulty. No postoperative complications like hepatic failure and anastomotic insufficiency were observed. The patient is alive with iung metastases 2 years and 6 months postoperatively without evidence of liver recurrence. This case showed that extensive hepatectomy for patients with H₃ prolonged their survival and that simultaneous aggressive hepatectomy and intestinal resection based on preoperative detailed estimation of the liver function and volume were effective because of the low burden for the patients and the reduction of tumor bearing time compared with a metachronous operation.

Key words
colorectal cancer, multiple liver metastases, simultaneous hepatectomy and intestinal resection

Reprint requests
Murato Miura The First Department of Surgery, The University of Tokushima School of Medicine
3-18-15 Kuramoto-cho, Tokushima-city, 770-8503 JAPAN

Accepted
May 19, 1998

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