Hepatectomy with Reconstruction of the Middle Hepatic Vein Using a Patch Graft for Liver Metastasis from Colorectal Cancer Involving the Vein—Report of Two Cases—

Abstract

Hepatectomy with reconstruction of the hepatic vein using a patch graft is useful if the functional liver volume is not sufficient. We report the usefulness of this patch graft reconstruction in two cases of liver metastasis from rectal cancer involving the root of the middle hepatic vein (MHV).
Case 1 involved a 66-year-old man who had rectal cancer with concomitant liver metastasis in the segment IV, whose root of the MHV had been involved by the tumor. Considering liver impairment due to neoadjuvant chemotherapy, we performed left lobectomy with reconstruction of the MHV using an umbilical portion patch graft. An abdominal CT scan performed 7 months after the operation confirmed the patent MHV.
Case 2 involved a 75-year-old man who had rectal cancer with concomitant liver multiple metastases, whose root of the MHV had been involved by the tumor manly locating in segment II/III. We confirmed his functional liver volume to be insufficient and performed extended left lateral segmentectomy with the MHV and reconstruction of the MHV using an umbilical vein patch graft. We did partial resections for other tumors. An abdominal CT scan performed 8 months after the operation confirmed good blood flow through the MHV.
Reconstruction of the hepatic vein in hepatic resection for hepatic metastasis of colorectal cancer involving the root of the MHV is useful to maintain the functional liver volume as well as the radicalness of the treatment.