Abstract:
The best known treatment of the colorectal liver metastasis is the complete surgical excision with clean surgical margins. However,
liver resections sometimes cannot appear technically feasible due to the high number of metastases in the liver, in cases of recurrent
resections or invasion of the tumors to the major vascular structures or neighboring organs. Here, we presented a colorectal
recurrent liver metastasis invading the retrohepatic vena cava, right adrenal gland, and right diaphragm. En masse resection of
the tumor with caudate hepatectomy combined with vena cava resection and surrounding adrenal and diaphragm resections was
accomplished. Caval reconstruction was done by a 5 cm in length cryopreserved vena cava homograft under isolated caval clamping.
Postoperative period was uneventful and she was discharged on day 11. As a conclusion, combined liver and vena cava resection for
a recurrent colorectal liver metastasis is a feasible procedure even with additional neighboring organ resections. Isolated vena cava
occlusion with the preservation of the hepatic blood flow may decrease the risk of liver injury in case of previous chemotherapy for
liver metastasis.
