Retrohepatic inferior vena cava reconstruction with saphenous vein patch in advanced stage cholangiocarcinoma

Hepatic resection is the only known curative treatment option in primary and metastatic liver tumors. Unlike other types of malignancies, the response rate to even the best chemotherapy protocols is quite low in liver malignancies. Survival is expressed in months in untreated liver malignancies or in patients with residual tumor after resection. The optimal survival can be achieved only by liver resection with negative surgical margins. In order to increase the number of patients suitable for hepatic resection, techniques such as portal vein embolization, neoadjuvant chemotherapy, two-step hepatectomy, re-do hepatectomy, hypothermic liver perfusion have been developed and newer modalities are still being investigated. Primary liver malignancies like hepatocellular carcinoma and cholangiocarcinoma, and metastatic liver tumors can invade the retrohepatic vena cava due to anatomical proximity. Invasion of either the hepatocaval confluence or vena cava are often considered as contraindications for liver resection due to the risk of intraoperative massive air embolism or hemorrhage. In this article, we present a patient who underwent left hepatectomy together with vena cava resection and reconstruction with saphenous vein patch due to cholangiocarcinoma.