Left Hepatectomy Enlarged to Segment 1 with Total Vascular Exclusion of the Liver Preserving the Caval Flow with Temporary Portacaval Shunt and Hypothermic Oxygenated Portal Perfusion on Machine for Metastatic Recurrence of a Pleural Chondrosarcoma.

Abstract

Background: Total vascular exclusion (TVE) of the liver preserving the caval flow with portal hypothermic perfusion and temporary portacaval shunt (PCS) is a validated technique for tumors invading the hepatic veins (HV) close to their confluence with the inferior vena cava (IVC). It prevents the risk of haemorrhage, gas embolism and avoids the haemodynamic consequences of clamping the IVC and veno-venous bypass. No published cases have reported using hypothermic oxygenated perfusion machine.

Patients and methods: The patient was a 58-year-old woman presenting a recurrent metastatic pleural chondrosarcoma, with a pleural metastasis and several intra-abdominal metastases, including a lesion localized in segment 1 close to the hilar plate and invading the left HV near its abutment in the IVC. A left hepatectomy enlarged to segment 1 was performed under TVE preserving the caval flow with in situ hypothermic portal perfusion of the liver using perfusion machine.

Results: PV clamping lasted 57 min, and 2 l of preservative solution were perfused. The maximum pressure in the PV was 10 mmHg and oxygen flow was regulated at 2 L/min. The resection was complete and margins were negative. Liver temperature was monitored at 5-6 °C. Postoperative follow-up was favourable, with hospital discharge at 16 days after surgery.

Discussion: The use of hypothermic oxygenated perfusion machine is therefore possible in this technique. In parallel with the results obtained in liver transplantation on marginal grafts, it could probably reduce ischemia-reperfusion injury of the remnant parenchyma compared with static cold storage and improve post-operative outcome.