Portal vein ligation and in situ liver splitting in metastatic liver cancer
Afag Aghayeva1, Bilgi Baca1, Deniz Atasoy1
, Sina Ferahman2, Sezgin Uludağ2, İsmail Ahmet Bilgin3, Sonay Beyatlı4, İsmail Mihmanlı5, İsmail Hamzaoğlu3
1Department of General Surgery, Acıbadem University School of Medicine Atakent Hospital, İstanbul, Turkey
2Department of General Surgery, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
3Department of General Surgery, Acıbadem University School of Medicine Maslak Hospital, İstanbul, Turkey
4Student of Acıbadem University School of Medicine, İstanbul, Turkey
5Department of Radiology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
Abstract
The most serious complication after major liver resection is liver failure. Depending on preoperative liver function, a future liver remnant of 25%-40% is considered sufficient to avoid postoperative liver failure. A new technique known as 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 male patient with a diagnosis of sigmoid adenocarcinoma and liver metastasis underwent anterior resection because of an obstructing sigmoid tumor and received palliative chemotherapy. After chemotherapy, abdominal computed tomography revealed a lesion, 50 mm in diameter, localized between segments 5-8 of the liver on the bifurcation of the anteroposterior segmental branch of the right portal vein. Computed tomography volumetric assessments of the liver were performed in the preoperative period, and it was found that the remnant left liver volume was less than 25%. In the first stage, portal vein ligation and in situ splitting of the liver parenchyma were performed. On the second and sixth postoperative days, computed tomography revealed hypertrophy of the left liver lobe. On the sixth day, a right hepatectomy was performed. Portal vein ligation combined with in situ splitting has been used by surgeons worldwide to obtain rapid and adequate liver hypertrophy. This new approach yields hope for patients with locally advanced liver tumors and may increase the number of curative resections for primary or metastatic liver tumors.
Keywords: Portal vein ligation, in situ liver splitting, metastatic liver cancer
This study was presented at the 19th National Surgical Congress, 16-20 April 2014, Antalya, Turkey.
Cite this paper as: Aghayeva A, Baca B, Atasoy D, Ferahman S, Uludağ S, Bilgin İA, et al. Portal vein ligation and in situ liver splitting in metastatic liver cancer. Turk J Surg 2018; 34(4): 327-330.
Written informed consent was obtained from patient who participated in this study.
Externally peer-reviewed.
Concept - B.B., İ.H., İ.M.; Design - A.A., B.B., D.A.; Supervision - İ.H., B.B., A.A.; Resource - S.F., S.U., İ.A.B.; Materials - A.A., B.B., S.B.; Data Collection and/or Processing - A.A., S.B., İ.A.B.; Analysis and/or Interpretation - D.A., A.A., B.B.; Literature Search - S.F., S.U., A.A.; Writing Manuscript - A.A., D.A., B.B.; Critical Reviews - B.B., İ.H., İ.M.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.