2017 Volume 50 Issue 1 Pages 18-25
A 71-year-old woman was admitted to our hospital because of a work-up for severe anemia. She was found to have advanced transverse colon cancer and 2 lesions of liver metastases in segments 5 and 8, respectively. At this point, unawareness of the right-sided ligamentum teres (RSLT) in this patient misled us into thinking that a central bisegmentectomy would be required to eradicate the liver tumors. Thus the left hemicolectomy was preceded, as the simultaneous colon and major liver resections were considered to be highly invasive. Five months later, we planned hepatectomy following six courses of chemotherapy. The 3-dimensional CT (3D-CT) analysis and simulation before hepatectomy revealed that the ligamentum teres was located in the right side of the Rex-Cantlie line, establishing the diagnosis of RSLT along with the portal vein anomalies. R0 resection was achieved by parenchymal-preserving hepatectomy with anatomical resection of the dorsal area of the right paramedian sector in accordance with preoperative 3D-CT simulation. She is doing well without recurrence 3 years after the first operation. Because RSLT frequently accompanies the portal system anomalies, it is of great importance for surgeons to first be aware of the presence of this anomaly before surgery and to make a careful resection plan using 3D-CT simulation for safe anatomical liver resections in patients with RSLT.
