Resection of metastatic liver tumors with special reference to hepatic venous system

When the right and middle hepatic veins (RHV and MHV) and all the short hepatic veins are removed during resection of segments (S) 7 + 8 including the caudate lobe, the remainder of (S) 5 + 6 shows congestion.

The subjects were 8 patients undergoing hepatectomy (7 with hepatic metastases of colorectal carcinoma and 1 with pancreatic carcinoid) for tumors located in the region circumscribed by the RHV, MHV, and inferior vena cava. Direct hepatic vein anastomosis was done in 5 patients, graft replacement of the MHV was done in 1 patient, and graft replacement of the RHV was done in 2 patients.

Hepatic vein reconstruction took approximately 20 min to complete. All 8 patients had an uneventful postoperative course and the anastomosis was patent at one month after operation. Three patients died of recurrent carcinoma at 6, 30, and 48 months after operation, respectively. Five have remained alive and disease-free for 18, 30, 46, 67, and 79 months, respectively.

Hepatic vein reconstruction is a beneficial option in hepatectomy for patients with carcinoma invading the major hepatic veins and short hepatic veins, since it can allow radical tumor resection and preserves the remnant liver function. In particular, direct hepatic vein anastomosis is recommended because it is a simple technique with good results.