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Annals of Surgical Oncology

, Volume 23, Supplement 5, pp 911–911 | Cite as

PTFE Graft as a “Bridge” to Communicating Veins Maturation in the Treatment of an Intrahepatic Cholangiocarcinoma Involving the 3 Hepatic Veins. The Minor-but-Complex Liver Resection

  • Lucio Urbani
  • Riccardo Balestri
  • Francesco Sidoti
  • Juri Riccardo Bernardini
  • Francesco Arces
  • Gabriella Licitra
  • Chiara Leoni
  • Francesco Forfori
  • Piero Colombatto
  • Piero Boraschi
  • Maura Castagna
  • Piero BucciantiEmail author
Hepatobiliary Tumors

Abstract

Background

Parenchyma-sparing liver surgery allows resecting hepatic veins (HV) at the hepatocaval confluence with minor (<3 adjacent segments) liver resections. PTFE graft can be used as a bridge to communicating-veins maturation to ensure the correct outflow of the spared liver. We present a video of an intrahepatic cholangiocarcinoma (IC) involving the three HV at the hepatocaval confluence treated with this approach.

Methods

In a 50-year old obese (BMI 44.8) male a 6-cm IC involving the hepatocaval confluence was identified during the follow-up for a kidney malignancy. At the preoperative CT scan the left HV was not detectable, the middle HV was incorporated within the tumor, and right HV had a 3-cm contact with the tumor. No communicating veins were evident at preoperative imaging.

Results

After a J-shape thoracophrenolaparotomy, the resection of segments II–III–IVa was partially extended to segment VIII–VII and I. The right HV was detached from the tumor, and the middle HV was reconstructed with a 7-mm ringed-armed PTFE graft anastomosed to V8. Surgery lasted 20 h and 55 min with an estimated blood loss of 3500 ml, but the postoperative course was uneventful and the patient was discharged on the 14th postoperative day. One month later the CT scan showed a patent PTFE graft with the maturation of communicating-veins. One year later a complete thrombosis of the PTFE graft was observed with normal liver perfusion and function, and the patient was disease-free.

Conclusions

PTFE-based parenchyma-sparing liver resection is a new tool to treat tumors located at the hepatocaval confluence exploiting the maturation of intrahepatic communicating-veins between main HV.

Supplementary material

Supplementary material 1 (MP4 91416 kb)

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Lucio Urbani
    • 1
  • Riccardo Balestri
    • 1
  • Francesco Sidoti
    • 1
  • Juri Riccardo Bernardini
    • 1
  • Francesco Arces
    • 1
  • Gabriella Licitra
    • 2
  • Chiara Leoni
    • 2
  • Francesco Forfori
    • 2
  • Piero Colombatto
    • 3
  • Piero Boraschi
    • 4
  • Maura Castagna
    • 5
  • Piero Buccianti
    • 1
    Email author
  1. 1.General SurgeryAzienda Ospedaliero-Universitaria PisanaPisaItaly
  2. 2.AnesthesiologyAzienda Ospedaliero-Universitaria PisanaPisaItaly
  3. 3.HepatologyAzienda Ospedaliero-Universitaria PisanaOspedaleItaly
  4. 4.RadiologyAzienda Ospedaliero-Universitaria PisanaPisaItaly
  5. 5.PathologyAzienda Ospedaliero-Universitaria PisanaPisaItaly

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