Left Superior Hepatectomy and Segment 6 Resection for Colorectal Cancer Metastasis Invading the Left Hepatic Vein: An Actual Parenchyma Preserving Technique

Safak Ozturk; Mutlu Unver; Burcin Kibar Ozturk; Osman Bozbıyık; Varlık Erol; Eyup Kebabcı; Mustafa Olmez; Cengiz Aydın; Gökhan Akbulut

doi:doi:10.11648/j.js.20140202.11

Left Superior Hepatectomy and Segment 6 Resection for Colorectal Cancer Metastasis Invading the Left Hepatic Vein: An Actual Parenchyma Preserving Technique

Safak Ozturk, Mutlu Unver, Burcin Kibar Ozturk, Osman Bozbıyık, Varlık Erol, Eyup Kebabcı, Mustafa Olmez, Cengiz Aydın, Gökhan Akbulut

Published in Journal of Surgery (Volume 2, Issue 2)

Received: 25 February 2014 Published: 20 March 2014

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Abstract

Introduction: Hepatic metastasis is the most common form of distant spread of colorectal cancer (CRC) with about 50% occurrence rate. Liver resection (LR) with R0 margins is the only curative treatment and is believed to have improved the long-term out-come of these patients. Because of a chemotherapeutic injury to the liver, preservation of as much parenchymal volume as possible to minimize the risk of liver failure is the most important issue in these group of patients.Our present report describes a parenchyma preserving technique with left superior hepatectomy and segment 6 resection in a case. Case Report: A 64- year- old woman presented to our instution with a colorectal liver metastasis. PET-CT scan showed solitary liver lesions in segment 2-4a and 6. A left superior hepatectomy (segment 2 and 4a) and segment 6 resection was performed with glissonian approach and clemp-crush technique. Left hepatic vein was ligated without blocking the venous and biliary drainage of segment 4b and segment 3. Pathological examination of the specimen showed tumor-free margins (R0 resection). Discussion: Developments in imaging modalities provide an improved visualization of hepatic segmental anatomy and also provide volumetric calculation on the liver. This allows a successful planning for segmental liver resections with a minimum risk of postoperative liver failure. Factors that were considered contraindications for the surgery, such as number of metastases, tumor size, synchronous metastases and the presence of extrahepatic disease, must be evaluated as prognostic factors and must not prevent these patients opportunity of being treated. The main consideration is to achieve a complete R0 resection. A 1cm-R0 surgical margin width has been considered to avoid local intrahepatic recurrence and optimize long-term survival after hepatic resection for colorectal cancer metastases but tumor biology is a more important predictor for intrahepatic recurrence rather than milimetres. Conclusion: Preservation of as much parenchymal volume as possible in order to minimize the risk of liver failure is required in liver resections with chemotherapeutic liver injury. Drainage of the remaining liver segments into the retrohepatic vena cava via the retrohepatic veins and communicating veins between adjacent hepatic veins may allow adequate liver outflow and remaining functional liver parenchyma in selected cases with hepatic vein invasion.

Published in	Journal of Surgery (Volume 2, Issue 2)
DOI	10.11648/j.js.20140202.11
Page(s)	21-23
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2014. Published by Science Publishing Group

Keywords

Colorectal Neoplasms, Hepatic Veins, Hepatectomy, Liver, Neoplasm Metastasis

References

[1]	Chan KM, Chiang JM, Lee CF et al. Outcomes of resection for colorectal cancer hepatic metastases stratified by evolving eras of treatment. World Journal of surgical Oncology 2011; 9: 174-183.
[2]	Sotiropoulos GC, Timm S, Radtke A, Molmenti EP, Lang H. Cranial Mesohepatectomy: Challenging Parenchyma-Preserving Operation for Colorectal Liver Metastases. Int J Colorectal Dis 2009; 24: 243.
[3]	Gallinger S, Biagi JJ, Fletcher GG, Nhan C, Ruo L, Mcleod RS. Liver resection for colorectal cancer metastases. Curr Oncol 2013; 20(3): 255-265.
[4]	Jamal MH, Hassanain M, Chaudhury P et al. Staged hepatectomy for bilobar colorectal hepatic metastases. HPB 2012; 14: 782-9.
[5]	Coimbra FJF, Pires TC, Junior WLC, Dınız AL, Ribeiro HSC. Advances in the surgical treatment of colorectal liver metastases. Rev Assoc Med Bras 2011; 57(2): 215-222.
[6]	Mohammad WM, Balaa FK. Surgical Management of Colorectal Liver Metastases. Clinics in Colon and Rectal Surgery 2009; 22(4): 225-232.
[7]	Neumann UP, Seehofer D, Neuhaus P. The Surgical Treatment of Hepatic Metastases in Colorectal Carcinoma. Dtsch Arztebl Int 2010; 107(19): 335-342.
[8]	Poultsides GA, Schulick RD, Pawlik TM. Hepatic resection for colorectal metastases: the impact of surgical margin status on outcome. HPB 2010; 12: 43-9.
[9]	Herman P, Pinheiro RS, Mello ES et al. Surgical Margin Size in Hepatic Resections for Colorectal Metastasis: Impact on recurrence and Survival. ABCD Arq Bras Cir Dig 2013; 26(4): 309-314.
[10]	Guye ML, Schoellhammer HF, Chiu LW, Kim J, Lai LL, Sinqh G. Designing Liver Resections and Pushing the Envelope with Resections for Hepatic Colorectal Metastases. Indian J Surg Oncol 2013; 4(4): 349-355.

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Safak Ozturk, Mutlu Unver, Burcin Kibar Ozturk, Osman Bozbıyık, Varlık Erol, et al. (2014). Left Superior Hepatectomy and Segment 6 Resection for Colorectal Cancer Metastasis Invading the Left Hepatic Vein: An Actual Parenchyma Preserving Technique. Journal of Surgery, 2(2), 21-23. https://doi.org/10.11648/j.js.20140202.11

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ACS Style

Safak Ozturk; Mutlu Unver; Burcin Kibar Ozturk; Osman Bozbıyık; Varlık Erol, et al. Left Superior Hepatectomy and Segment 6 Resection for Colorectal Cancer Metastasis Invading the Left Hepatic Vein: An Actual Parenchyma Preserving Technique. J. Surg. 2014, 2(2), 21-23. doi: 10.11648/j.js.20140202.11

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AMA Style

Safak Ozturk, Mutlu Unver, Burcin Kibar Ozturk, Osman Bozbıyık, Varlık Erol, et al. Left Superior Hepatectomy and Segment 6 Resection for Colorectal Cancer Metastasis Invading the Left Hepatic Vein: An Actual Parenchyma Preserving Technique. J Surg. 2014;2(2):21-23. doi: 10.11648/j.js.20140202.11

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@article{10.11648/j.js.20140202.11,
  author = {Safak Ozturk and Mutlu Unver and Burcin Kibar Ozturk and Osman Bozbıyık and Varlık Erol and Eyup Kebabcı and Mustafa Olmez and Cengiz Aydın and Gökhan Akbulut},
  title = {Left Superior Hepatectomy and Segment 6 Resection for Colorectal Cancer Metastasis Invading the Left Hepatic Vein: An Actual Parenchyma Preserving Technique},
  journal = {Journal of Surgery},
  volume = {2},
  number = {2},
  pages = {21-23},
  doi = {10.11648/j.js.20140202.11},
  url = {https://doi.org/10.11648/j.js.20140202.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20140202.11},
  abstract = {Introduction: Hepatic metastasis is the most common form of distant spread of colorectal cancer (CRC) with about 50% occurrence rate. Liver resection (LR) with R0 margins is the only curative treatment and is believed to have improved the long-term out-come of these patients. Because of a chemotherapeutic injury to the liver, preservation of as much parenchymal volume as possible to minimize the risk of liver failure is the most important issue in these group of patients.Our present report describes a parenchyma preserving technique with  left superior hepatectomy and segment 6 resection in a case. Case Report: A 64- year- old woman presented to our instution with a colorectal liver metastasis. PET-CT scan showed solitary liver lesions in segment 2-4a and 6. A left superior hepatectomy (segment 2 and 4a) and segment 6 resection was performed with glissonian approach and clemp-crush technique. Left hepatic vein was ligated without blocking the venous and biliary drainage of segment 4b and segment 3. Pathological examination of the specimen showed tumor-free margins (R0 resection). Discussion: Developments in imaging modalities provide an improved visualization of hepatic segmental anatomy and also provide volumetric calculation on the liver. This allows a successful planning for segmental liver resections with a minimum risk of postoperative liver failure. Factors that were considered contraindications for the surgery, such as number of metastases, tumor size, synchronous metastases and the presence of extrahepatic disease, must be evaluated as prognostic factors and must not prevent these patients opportunity of being treated. The main consideration is to achieve a complete R0 resection. A 1cm-R0 surgical margin width has been considered to avoid local intrahepatic recurrence and optimize long-term survival after hepatic resection for colorectal cancer metastases but tumor biology is a more important predictor for intrahepatic recurrence rather than milimetres. Conclusion: Preservation of as much parenchymal volume as possible in order to minimize the risk of liver failure is required in liver resections with chemotherapeutic liver injury. Drainage of the remaining liver segments into the retrohepatic vena cava via the retrohepatic veins and communicating veins between adjacent hepatic veins may allow adequate liver outflow and remaining functional liver parenchyma in selected cases with hepatic vein invasion.},
 year = {2014}
}

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TY  - JOUR
T1  - Left Superior Hepatectomy and Segment 6 Resection for Colorectal Cancer Metastasis Invading the Left Hepatic Vein: An Actual Parenchyma Preserving Technique
AU  - Safak Ozturk
AU  - Mutlu Unver
AU  - Burcin Kibar Ozturk
AU  - Osman Bozbıyık
AU  - Varlık Erol
AU  - Eyup Kebabcı
AU  - Mustafa Olmez
AU  - Cengiz Aydın
AU  - Gökhan Akbulut
Y1  - 2014/03/20
PY  - 2014
N1  - https://doi.org/10.11648/j.js.20140202.11
DO  - 10.11648/j.js.20140202.11
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 21
EP  - 23
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20140202.11
AB  - Introduction: Hepatic metastasis is the most common form of distant spread of colorectal cancer (CRC) with about 50% occurrence rate. Liver resection (LR) with R0 margins is the only curative treatment and is believed to have improved the long-term out-come of these patients. Because of a chemotherapeutic injury to the liver, preservation of as much parenchymal volume as possible to minimize the risk of liver failure is the most important issue in these group of patients.Our present report describes a parenchyma preserving technique with  left superior hepatectomy and segment 6 resection in a case. Case Report: A 64- year- old woman presented to our instution with a colorectal liver metastasis. PET-CT scan showed solitary liver lesions in segment 2-4a and 6. A left superior hepatectomy (segment 2 and 4a) and segment 6 resection was performed with glissonian approach and clemp-crush technique. Left hepatic vein was ligated without blocking the venous and biliary drainage of segment 4b and segment 3. Pathological examination of the specimen showed tumor-free margins (R0 resection). Discussion: Developments in imaging modalities provide an improved visualization of hepatic segmental anatomy and also provide volumetric calculation on the liver. This allows a successful planning for segmental liver resections with a minimum risk of postoperative liver failure. Factors that were considered contraindications for the surgery, such as number of metastases, tumor size, synchronous metastases and the presence of extrahepatic disease, must be evaluated as prognostic factors and must not prevent these patients opportunity of being treated. The main consideration is to achieve a complete R0 resection. A 1cm-R0 surgical margin width has been considered to avoid local intrahepatic recurrence and optimize long-term survival after hepatic resection for colorectal cancer metastases but tumor biology is a more important predictor for intrahepatic recurrence rather than milimetres. Conclusion: Preservation of as much parenchymal volume as possible in order to minimize the risk of liver failure is required in liver resections with chemotherapeutic liver injury. Drainage of the remaining liver segments into the retrohepatic vena cava via the retrohepatic veins and communicating veins between adjacent hepatic veins may allow adequate liver outflow and remaining functional liver parenchyma in selected cases with hepatic vein invasion.
VL  - 2
IS  - 2
ER  -

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Author Information

Safak Ozturk

Department of General Surgery Clinic, T.C.S.B. Tepecik Teaching and Research Hospital, Izmir, Turkey
Mutlu Unver

Department of General Surgery Clinic, T.C.S.B. Tepecik Teaching and Research Hospital, Izmir, Turkey
Burcin Kibar Ozturk

Department of Radiology, Ege University Faculty of Medicine, Izmir, Turkey
Osman Bozbıyık
Varlık Erol
Eyup Kebabcı
Mustafa Olmez

Department of General Surgery Clinic, T.C.S.B. Tepecik Teaching and Research Hospital, Izmir, Turkey
Cengiz Aydın
Gökhan Akbulut

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APA Style

Safak Ozturk, Mutlu Unver, Burcin Kibar Ozturk, Osman Bozbıyık, Varlık Erol, et al. (2014). Left Superior Hepatectomy and Segment 6 Resection for Colorectal Cancer Metastasis Invading the Left Hepatic Vein: An Actual Parenchyma Preserving Technique. Journal of Surgery, 2(2), 21-23. https://doi.org/10.11648/j.js.20140202.11

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ACS Style

Safak Ozturk; Mutlu Unver; Burcin Kibar Ozturk; Osman Bozbıyık; Varlık Erol, et al. Left Superior Hepatectomy and Segment 6 Resection for Colorectal Cancer Metastasis Invading the Left Hepatic Vein: An Actual Parenchyma Preserving Technique. J. Surg. 2014, 2(2), 21-23. doi: 10.11648/j.js.20140202.11

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AMA Style

Safak Ozturk, Mutlu Unver, Burcin Kibar Ozturk, Osman Bozbıyık, Varlık Erol, et al. Left Superior Hepatectomy and Segment 6 Resection for Colorectal Cancer Metastasis Invading the Left Hepatic Vein: An Actual Parenchyma Preserving Technique. J Surg. 2014;2(2):21-23. doi: 10.11648/j.js.20140202.11

Copy | Download

@article{10.11648/j.js.20140202.11,
  author = {Safak Ozturk and Mutlu Unver and Burcin Kibar Ozturk and Osman Bozbıyık and Varlık Erol and Eyup Kebabcı and Mustafa Olmez and Cengiz Aydın and Gökhan Akbulut},
  title = {Left Superior Hepatectomy and Segment 6 Resection for Colorectal Cancer Metastasis Invading the Left Hepatic Vein: An Actual Parenchyma Preserving Technique},
  journal = {Journal of Surgery},
  volume = {2},
  number = {2},
  pages = {21-23},
  doi = {10.11648/j.js.20140202.11},
  url = {https://doi.org/10.11648/j.js.20140202.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20140202.11},
  abstract = {Introduction: Hepatic metastasis is the most common form of distant spread of colorectal cancer (CRC) with about 50% occurrence rate. Liver resection (LR) with R0 margins is the only curative treatment and is believed to have improved the long-term out-come of these patients. Because of a chemotherapeutic injury to the liver, preservation of as much parenchymal volume as possible to minimize the risk of liver failure is the most important issue in these group of patients.Our present report describes a parenchyma preserving technique with  left superior hepatectomy and segment 6 resection in a case. Case Report: A 64- year- old woman presented to our instution with a colorectal liver metastasis. PET-CT scan showed solitary liver lesions in segment 2-4a and 6. A left superior hepatectomy (segment 2 and 4a) and segment 6 resection was performed with glissonian approach and clemp-crush technique. Left hepatic vein was ligated without blocking the venous and biliary drainage of segment 4b and segment 3. Pathological examination of the specimen showed tumor-free margins (R0 resection). Discussion: Developments in imaging modalities provide an improved visualization of hepatic segmental anatomy and also provide volumetric calculation on the liver. This allows a successful planning for segmental liver resections with a minimum risk of postoperative liver failure. Factors that were considered contraindications for the surgery, such as number of metastases, tumor size, synchronous metastases and the presence of extrahepatic disease, must be evaluated as prognostic factors and must not prevent these patients opportunity of being treated. The main consideration is to achieve a complete R0 resection. A 1cm-R0 surgical margin width has been considered to avoid local intrahepatic recurrence and optimize long-term survival after hepatic resection for colorectal cancer metastases but tumor biology is a more important predictor for intrahepatic recurrence rather than milimetres. Conclusion: Preservation of as much parenchymal volume as possible in order to minimize the risk of liver failure is required in liver resections with chemotherapeutic liver injury. Drainage of the remaining liver segments into the retrohepatic vena cava via the retrohepatic veins and communicating veins between adjacent hepatic veins may allow adequate liver outflow and remaining functional liver parenchyma in selected cases with hepatic vein invasion.},
 year = {2014}
}

Copy | Download

TY  - JOUR
T1  - Left Superior Hepatectomy and Segment 6 Resection for Colorectal Cancer Metastasis Invading the Left Hepatic Vein: An Actual Parenchyma Preserving Technique
AU  - Safak Ozturk
AU  - Mutlu Unver
AU  - Burcin Kibar Ozturk
AU  - Osman Bozbıyık
AU  - Varlık Erol
AU  - Eyup Kebabcı
AU  - Mustafa Olmez
AU  - Cengiz Aydın
AU  - Gökhan Akbulut
Y1  - 2014/03/20
PY  - 2014
N1  - https://doi.org/10.11648/j.js.20140202.11
DO  - 10.11648/j.js.20140202.11
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 21
EP  - 23
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20140202.11
AB  - Introduction: Hepatic metastasis is the most common form of distant spread of colorectal cancer (CRC) with about 50% occurrence rate. Liver resection (LR) with R0 margins is the only curative treatment and is believed to have improved the long-term out-come of these patients. Because of a chemotherapeutic injury to the liver, preservation of as much parenchymal volume as possible to minimize the risk of liver failure is the most important issue in these group of patients.Our present report describes a parenchyma preserving technique with  left superior hepatectomy and segment 6 resection in a case. Case Report: A 64- year- old woman presented to our instution with a colorectal liver metastasis. PET-CT scan showed solitary liver lesions in segment 2-4a and 6. A left superior hepatectomy (segment 2 and 4a) and segment 6 resection was performed with glissonian approach and clemp-crush technique. Left hepatic vein was ligated without blocking the venous and biliary drainage of segment 4b and segment 3. Pathological examination of the specimen showed tumor-free margins (R0 resection). Discussion: Developments in imaging modalities provide an improved visualization of hepatic segmental anatomy and also provide volumetric calculation on the liver. This allows a successful planning for segmental liver resections with a minimum risk of postoperative liver failure. Factors that were considered contraindications for the surgery, such as number of metastases, tumor size, synchronous metastases and the presence of extrahepatic disease, must be evaluated as prognostic factors and must not prevent these patients opportunity of being treated. The main consideration is to achieve a complete R0 resection. A 1cm-R0 surgical margin width has been considered to avoid local intrahepatic recurrence and optimize long-term survival after hepatic resection for colorectal cancer metastases but tumor biology is a more important predictor for intrahepatic recurrence rather than milimetres. Conclusion: Preservation of as much parenchymal volume as possible in order to minimize the risk of liver failure is required in liver resections with chemotherapeutic liver injury. Drainage of the remaining liver segments into the retrohepatic vena cava via the retrohepatic veins and communicating veins between adjacent hepatic veins may allow adequate liver outflow and remaining functional liver parenchyma in selected cases with hepatic vein invasion.
VL  - 2
IS  - 2
ER  -

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