Segment IV resection (redo hepatectomy) - TVASurg - The Toronto Video Atlas of Surgery

Case description

The patient is a 46 year old woman.
The patient was originally diagnosed with sigmoid cancer and synchronous liver metastases 6 years prior to the time of the operation detailed in the accompanying video.
The liver metastases were bilateral and multiple. Her sigmoid colon was resected, and she went on to have multiple courses of chemotherapy. The liver metastases responded, and she underwent a staged liver resection: a right hepatectomy, followed 2 months later by a non-anatomic partial left hepatectomy.
She went on to develop a solitary lung metastasis - this was resected as well.
Roughly one year before the current operation she developed a recurrent liver metastasis at the apex of the ascending branch of the left portal vein. She was treated with radiotherapy, and then aggressive chemotherapy. The liver lesion did shrink but still appeared very close (if not adherent) to the apex of the left portal vein.
After discussion at multiple multi-disciplinary tumour boards, it was elected to offer the patient re-do liver resection, possibly with in situ cold perfusion of the liver to permit reconstruction of the left portal vein.

Surgical plan

Complex re-do liver resection in an irradiated field.
Potential need for reconstruction of the apex of the left portal vein - plan for total vascular exclusion of the liver with in situ cold perfusion of the liver.
Likely need for biliary reconstruction.

CT scans (venous phase)

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