Portal vein ligation and in situ liver splitting in metastatic liver cancer

Özet

The most serious complication after major liver resection is liver failure. Depending on preoperative liver function, afuture liver remnant of 25%-40% is considered sufficient to avoid postoperative liver failure. A new technique knownas portal vein ligation combined with in situ splitting has been developed to obtain rapid liver hypertrophy. Herein, we present a case where we performed portal vein ligation combined with in situ splitting. A 37-year-old malepatient with a diagnosis of sigmoid adenocarcinoma and liver metastasis underwent anterior resection because ofan obstructing sigmoid tumor and received palliative chemotherapy. After chemotherapy, abdominal computedtomography revealed a lesion, 50 mm in diameter, localized between segments 5-8 of the liver on the bifurcationof the anteroposterior segmental branch of the right portal vein. Computed tomography volumetric assessments ofthe liver were performed in the preoperative period, and it was found that the remnant left liver volume was lessthan 25%. In the first stage, portal vein ligation and in situ splitting of the liver parenchyma were performed. Onthe second and sixth postoperative days, computed tomography revealed hypertrophy of the left liver lobe. On thesixth day, a right hepatectomy was performed. Portal vein ligation combined with in situ splitting has been usedby surgeons worldwide to obtain rapid and adequate liver hypertrophy. This new approach yields hope for patientswith locally advanced liver tumors and may increase the number of curative resections for primary or metastaticliver tumors.