In the meantime the patient
was treated with octreotide. Six weeks after the embolization the
size of the left lobe was increased by 40% of the initial size,
as documented by the CT-scan (Fig. 4). |
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Fig. 4: CT scan |
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After bilateral subcostal
laparotomy, the tumor is visible on the anterior surface (Fig. 5) and hypertrophy of left lobe is confirmed.
By pulling up the liver, the tumor involving the caudate lobe is
showed under the hepatic pedicle (Fig. 6). |
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| Fig. 5: Operative field |
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Fig. 6: Operative field |
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Right hepatectomy extended
to segments 1 and 4 was performed. Pedicle clamping for 50 minutes
and total vascular exclusion for 15 minutes, with preservation of
the flow to the segments 2 and 3 (Fig. 7),
were used. Resection was performed without any blood transfusion. |
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Fig. 7: Caval clamping
during right hepatectomy enlarged to segments 1 and 4, with preservation
of blood inflow and outflow of segments 2 and 3. |
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Final view of segments
2 and 3 at the end of resection. |
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From the right to the left:
left bile duct (white loop), left portal branch (blue loop), left
hepatic artery (red loop). |
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| Final view from the right:
retro hepatic vena cava completely dissected and left lobe. |
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| Postoperative
outcome was complicated for biliary fistula healed after endoscopic
sphyncterotomy. No sign of liver failure was observed. |
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| Abdominal CT
scan 3 months after resection (Fig. 5). |
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Fig. 5: CT scan |
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