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HPB Surgery
Volume 11 (1999), Issue 4, Pages 265-270
http://dx.doi.org/10.1155/1999/24710
Case Report

Left Extended Hemihepatectomy With Preservation of Large Inferior Right Hepatic Vein: A Case Report

1The Department of Surgery, The Queen Elizabeth Hospital, Woodville Road, Woodville South, 5011, South Australia, Australia
2Department of Surgery, Royal Adelaide Hospital, The University of Adelaide, Australia

Received 5 November 1997; Accepted 1 July 1998

Copyright © 1999 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

For hepatic function to be preserved after an extended hemihepatectomy adequate venous drainage of the remaining liver is required. Most metastases close to the confluence of the superior hepatic veins are considered unresectable because hepatic venous outflow after resection would be compromised. In 10–25% of people, the inferior right hepatic vein is of large calibre. Thus the superior hepatic veins may be sacrificed and hepatic function preserved if a large inferior right hepatic vein is present.

A patient with involvement of segments 2, 4 and 8 by metastatic colorectal cancer is presented. This patient had a large inferior right hepatic vein, and so was able to undergo an extended left hemihepatectomy with ligation of all superior hepatic veins. Subsequent quality of life was maintained.

This case illustrates that an ‘unresectable’ hepatic lesion can be actually resectable if an alternative venous drainage is present. A pre-operative search for a prominent inferior right hepatic vein by ultrasound, computerised tomography, or even magnetic resonance imaging should be considered in these cases.