Whipple with extended right hepatectomy and right nephrectomy (Part II) - TVASurg

Case Description

A 27-year-old male presented with a sarcoma of the pancreas head that had engulfed the inferior vena cava and invaded the liver including segments I, VI and VII. The main portal vein, right hepatic artery, right renal artery and vein, and common bile duct were also involved.
A superficial femoral vein graft will be harvested to reconstruct the portal vein.
The specimen will be resected and the retrohepatic cava will be reconstructed to the left renal vein. Infrarenal caval flow has already been re-routed via the lumbar veins.
A roux limb of bowel is constructed, passed through a defect made in the transverse mesocolon, and a pancreaticojejunostomy with stent is performed.
Segment 2 and 3/4 bile duct orifices on the remnant left liver lobe are plastied together and a hepaticojejunostomy is performed.
A two-layer gastrojejunostomy is also performed, completing the reconstructions.

CT scans (Venous Phase)

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