Simultaneous S₃Excision+Extended Right Hepatectomy and Low Anterior Resection for Rectal Cancer with Multiple Liver Metastases (H₃)-A Report of a Case

Abstract

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 337ml after right extended hepatectomy. This volume was tnought to be enough for this patient because it was greater than half of the total normal liver and than theminimal essential liver volume of this patient. Based on this estimation, simultaneous S3 excision+extended right hepatectomy and low anterior resection with lymph node dissction (D₂) were carried out with no difficulty. No postoperative complications like hepatic failure and anastomotic insufficiency were observed. The patient is alive with lung metastases 2 years and 6 months postoper-atively without evidence of liver recurrence. This case showed that extensive hepatectomy for patients with H₃prolonged 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.