A new technique for resecting 'unresectable' liver tumors

Background/Purpose: Liver tumors that surround the three major hepatic vein s traditionally have been considered unresectable. This report describes an extended atypical left hepatectomy technique for tumors around the major h epatic veins. Methods: Three children with tumors surrounding the 3 hepatic veins underwe nt intraoperative evaluation for extended atypical left hepatectomy. The le ft hepatic artery, left branch of the portal vein, and the 3 hepatic veins are occluded with vascular clamps. Perfusion of the remaining liver is thro ugh the right hepatic artery and portal vein into the retrohepatic vena cav a via the retro hepatic veins. If the liver remains soft and does not becom e mottled, division of the 3 hepatic veins and resection of the tumor are c arried out. Results: Extended atypical left hepatectomy was successful in 2 children. B ile leak occurred in 1 instance and healed spontaneously. Both patients had transiently elevated serum bilirubin and transaminase levels and an elevat ed prothrombin time for 2 weeks. Both survived after treatment with chemoth erapy. In the third child the liver became tense and mottled, and the proce dure was abandoned. Conclusions: Successful extended atypical left hepatectomy depends on the a bility of the retro hepatic veins to adequately drain blood into the vena c ava after interruption (clamping) of the main hepatic veins, If the liver b ecomes mottled and tense the procedure must be abandoned and the patient sh ould be considered for hepatic transplantation. J Pediatr Surg 35:1294-1299 . Copyright (C) 2000 by W.B. Saunders Company.