A Case of Hepatocellular Carcinoma Resected by Right Trisegmentectomy with Hepatic Vein Reconstruction using Synthetic Graft

Abstract

A-73-year-old man infected with hepatitis type B virus and suffering upper right abdominal pain was hound in dynamic enhanced computed tomography (CT) to have 16×15×12cm hepatocellular carcinoma in the middle and right hepatic lobes, and invasion to V3 was suspected. Reconstructire 3-dimensional CT showed that the left hepatic vein diverged to confluence with V2 and V3 near the root, and V3 was compressed for 3cm by the A-73-year-old man infected with hepatitis type B virus and suffering upper right abdominal pain was hound in dynamic enhanced computed tomography (CT) to have 16×15×12cm hepatocellular carcinoma in the middle and right hepatic lobes, and invasion to V3 was suspected. Reconstructire 3-dimensional CT showed that the left hepatic vein diverged to confluence with V2 and V3 near the root, and V3 was compressed for 3cm by the tumor. We conducted right trisegmentectomy with vein reconstruction. The 1cm diameter Gore-Tex^®. expanded polytetrafluoroethylene graft was interposed between the segment 3 vein and inferior vena cava. Histpathological diagnosis was moderately differentiated hepatoceller carcinoma with capsule and septum. There was no vascular or biliary invasion. The surgical margin was free of invasion. The postoperative course was uneventful, and the man started to receive warfarin on postoperative day (POD) 6. He was discharged on POD 19. CT examination 6 months postoperatively showed graft patency. He remains alive with remnant liver recurrence and bone metastasis 1 year after operation.