Left hepatectomy with suprahepatic inferior vena cava resection and reconstruction under veno-arterial extracorporeal membrane oxygenation for intrahepatic cholangiocarcinoma: a case report

Abstract

Background Curative surgery is the most effective treatment for intrahepatic cholangiocarcinoma (ICC). When an ICC involves the suprahepatic inferior vena cava (IVC), hepatectomy with suprahepatic IVC resection and reconstruction is challenging. For reconstruction of the suprahepatic IVC, total hepatic vascular exclusion (THVE), veno-venous bypass, and/or in situ hypothermic portal perfusion are required, but mortality and morbidity remain high. Case presentation We present a 73-year-old woman with mass-forming ICC which invaded the suprahepatic IVC and middle hepatic vein. Left hepatectomy, suprahepatic IVC resection, and reconstruction with an artificial graft were successfully performed during veno-arterial extracorporeal membrane oxygenation (V-A ECMO) to maintain blood pressure. While clamping the IVC diagonally, the right hepatic vein confluence could be preserved. No congestion in the right liver was seen; therefore, there was no requirement for the Pringle maneuver or THVE during reconstruction. No morbidity or mortality was seen after surgery. Conclusions Hepatectomy with suprahepatic IVC resection and reconstruction under V-A ECMO can be performed safely. When an ICC invades the suprahepatic IVC, V-A ECMO during resection and reconstruction of the suprahepatic IVC with an artificial graft is recommended as one of the options.

Perioperative outcomes of utilizing infrahepatic inferior vena cava clamping and Pringle maneuver during hepatectomy: a meta-analysis

“…Intraoperative bleeding during hepatectomy, and subsequently need for blood transfusion are important predictors of adverse perioperative outcomes [ 3 , 21 ]. This meta-analysis identified that combination of IIVCC and PM is an effective surgical strategy to limit intraoperative blood loss and need for IOBT in comparison to PM alone approach.…”

“…During major hepatic resection, intraoperative blood loss may range from 200 to 2000 mL, with approximately 25.2–56.8% of patients requiring intraoperative blood transfusion [ 1 , 2 ]. Several studies have identified intraoperative blood loss and transfusions, during hepatectomy, as significant risk factors for perioperative morbidity and mortality [ 3 ]. Therefore, it remains crucial to identify and implement interventions to minimize intraoperative bleeding during hepatectomy.…”

Outcomes of Vascular Surgery Performed Jointly With Other Departments

“…Based on these results, tumor resection with vascular reconstruction is now being performed [ 6 ]. In some cases, extracorporeal circulation is used for resection of tumors that have invaded more centrally than the hepatic vein [ 7 ]. In addition to tumor resection and vascular reconstruction by standby surgery as described above, we are sometimes requested to perform repair due to unexpected vascular injury during surgery.…”