Hepato-cavo-atrial confluence resection without extracorporeal circulation

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Издатель
Video presented at I-HPBA (International Hepato-Pancreato Biliary Association) Virtual World Congress 2020. 27-30 November 2020.


VL01-01 Hepato-Cavo-Atrial Confluence Resection without Extracorporeal Circulation to Treat a Third Colorectal Metastasis Recurrence Involving Right Atrium
N. Roffi, L. Urbani

Azienda Ospedaliero-Universitaria Pisana - General Surgery - Liver Metastasis Parenchyma Sparing Surgical Team, Italy

Parenchyma sparing hepatectomy (PSH) allows for several surgeries in case of liver disease recurrence. This video shows treatment of a third colorectal liver metastasis (CRLM) recurrence at the hepato-caval confluence protruding in right atrium.
A 71y female received a first PSH (liver-tunnel) for two metachronous CRLM. One year later a second PSH with double HV reconstruction was performed for a new CRLM involving diaphragm, right hepatic vein (RHV) and middle hepatic vein. Eighteen months after, a third solid lesion appeared involving the hepato-caval confluence and protruding inside right atrium. Extracorporeal-circulation was contraindicated due to patient's general condition, but a multidisciplinary/professional team planned an alternative surgical approach.
J-shaped sterno-thoraco-laparotomy was performed to confirm extracorporeal circulation avoidance by tumor displacement from the right atrium using the “atrial-abdominalization manouvre”. A cadaveric vena cava graft was previously prepared replacing right renal with right iliac vein. Liver outflow was interrupted resecting intrahepatic RHV and middle-left hepatic vein common trunk. Common trunk was anastomosed with cadaveric right iliac vein under total vascular exclusion with caval flow preservation. Then, hepato-cavo-atrial confluence was resected and atrial junction was anastomosed with the cadaveric vena cava and the liver was reperfused (38 minutes from common-trunk-resection to liver-reperfusion). Finally, intrahepatic cava anastomosis was performed. Reconstruction of RHV was not required. Ten-months after surgery the patient is alive and well. Control CT scan documented no pathologic recurrences and regular anastomoses.
This video documented feasibility of hepato-cavo-atrial confluence replacement with a cadaveric graft without using extracorporeal circulation.
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