TREATMENT OF RECURRENT HEPATOCELLULAR-CARCINOMA BY HEPATECTOMY WITH RIGHT AND MIDDLE HEPATIC VEIN RECONSTRUCTION USING TOTAL VASCULAR EXCLUSION WITH EXTRACORPOREAL BYPASS AND HYPOTHERMIC HEPATIC PERFUSION - REPORT OF A CASE

We report herein the case of a patient who had previously undergone a lateral segmentectomy for hepatocellular carcinoma (HCC) in whom recur rent HCC invading the trunk of the right and middle hepatic veins in a damaged liver was treated by reconstruction of both hepatic veins, us ing total vascular exclusion with extracorporeal bypass and hypothermi c hepatic perfusion. Reconstruction was performed using a graft taken from the left external iliac vein and divided into two pieces. Hepatic ischemia lasted for 91 min during the procedure and the intrahepatic temperature, as monitored by inserting a needle-type thermometer, was decreased to 11 degrees C throughout the procedure, The peak levels of serum glutamic pyruvic transaminase, lactate dehydrogenase, and total bilirubin were 363 IU/l, 1198 IU/ml, and 2.8 mg/dl, respectively, on postoperative day (POD) 2, The patient's postoperative course was unev entful except for mild, temporary swelling of the left leg. Postoperat ive computed tomography and magnetic resonance imaging examinations di sclosed no obstruction of either graft, and the patient was discharged on POD 40.