Robotic Subtotal Caudate Lobe Hepatic Resection for Paracaval Colorectal Metastasis: Technique of Inferior Vena Cava Dissection and Handling.

Abstract

Background: Minimally invasive technique for surgical management of colorectal metastasis is becoming the standard practice in the United States. Paracaval colorectal metastasis is a technically challenging tumor to resect due to its location.^1-4 Abutment of the inferior vena cava (IVC) often requires advanced technique for vascular dissection and potential need for partial venous resection. The authors describe their technique of robotic subtotal caudate lobe resection for paracaval tumor requiring tangential IVC resection.

Methods: A 76-year-old man after partial nonanatomic liver resection of colorectal metastases in segments 2, 4, and 8 presented with a new paracaval caudate tumor. A positron emission tomography (PET) scan showed a 3-cm FDG avid tumor with a standard uptake value (SUV) of 8.3 without extrahepatic metastasis. After a diagnostic laparoscopy, subtotal caudate lobe resection was undertaken. Short hepatic veins were divided to fully mobilize the Spiegel and paracaval portion. Liver transection was performed along the right side of the IVC. Upon the final IVC dissection, vascular abutment by the dorsal aspect of the tumor was encountered. Meticulous vascular dissection, performed with partial tangential IVC resection, was completed to gain complete tumor resection.

Results: The operation time was 3.5 h, with 100 ml of blood loss. The postoperative course was uneventful, and the patient was discharged home on postoperative day 2. The pathology results showed a moderately differentiated metastatic adenocarcinoma (3.8 × 3 × 1.8 cm) with a histologically negative vascular margin. The patient currently is 2 years from the operation without recurrence of disease.

Conclusion: The authors describe a safe and feasible technique of robotic subtotal caudate lobe hepatic resection with partial IVC resection, which can be useful to practicing hepatobiliary surgeons.