Right hepatectomy with preservation of the entire caudate lobe in patients with metastatic liver tumors: a case of a new hepatectomy technique and treatment strategy for patients with marginal liver function

Abstract

Background Performing major hepatectomy for patients with marginal hepatic function is challenging. In some cases, the procedure is contraindicated owing to the threat of postoperative liver failure. In this case report, we present the first case of marginal liver function (indocyanine green clearance retention rate at 15 min [ICGR15]: 28%) successfully treated with right hepatectomy, resulting in total caudate lobe preservation. Case presentation A 71-year-old man was diagnosed with sigmoid colon cancer with three liver metastases (S5, S7, and S8). All of metastatic lesions shrunk after chemotherapy, but his ICGR15 and indocyanine green clearance rate (ICGK) were 21% and 0.12, respectively. Moreover, the remnant liver volume was only 39%. Therefore, portal venous embolism (PVE) of the right portal vein was suggested. Portography showed divergence of the considerably preserved right caudate lobe branch (PV1R) from the root of the right portal vein. The liver function was reevaluated 18 days after PVE was suggested. During this time, the ICGR15 (21–28%) and ICGK rate (0.12–0.10) deteriorated. The right caudate lobe was significantly enlarged; thus, a total caudate lobe-preserving hepatectomy (TCPRx) was performed. Patients eligible for TCPRx included those with (1) hepatocellular carcinoma or metastatic liver cancer, (2) no tumor in the caudate lobe, (3) marginal liver function (ICG Krem greater than 0.05 if TCPRx was adapted; otherwise, less than 0.05) and Child–Pugh classification category A, and (4) preserved PV1R and right caudate bile duct branch. The procedure was performed through (A) precise estimation of the remnant liver volume preoperatively, (B) repeated intraoperative cholangiography to confirm the biliary branch of the right caudate lobe (B1R) conservation, and (C) stapler division of posterior and anterior Glisson’s pedicles laterally to avoid injuries to the PV1R and B1R. Conclusions Right hepatectomy with total caudate lobe preservation, following PVE, was a safe and viable surgical technique for patients with marginal liver function.

Indocyanine Green (ICG) and Colorectal Surgery: A Literature Review on Qualitative and Quantitative Methods of Usage

“…Surgery may be contraindicated if hepatic failure is likely afterward. In a case report by Kato [ 83 ], a right hepatectomy effectively treated the first patient with reduced liver function (ICGR15: 28%), which allowed the preservation of the complete caudate lobe. ICGR15 and ICGK were 21% and 0.12%, respectively, although all metastatic lesions decreased after treatment.…”

Indocyanine Green(Icg) And Colorectal Surgery: A Literature Review on Qualitative and Quantitative Methods of Usage

“…Due to the likelihood of postoperative hepatic failure, surgery is contraindicated in some cases. In a case report by Kato [83], the first patient had limited liver function (ICGR15: 28%) and was successfully treated with a right hepatectomy, which allowed preservation of the complete caudate lobe. All metastatic lesions shrank after chemotherapy; however, the patient's ICGR15 and ICGK were 21% and 0.12%, respectively.…”

Quantitative Methods for the Use of Icg in Colorectal Surgery - An Updated Literature Review

“…In certain instances, the procedure is contraindicated due to the possibility of postoperative liver failure. In a case report by Kato [71], the first patient is presented with marginal liver function (indocyanine green clearance retention rate at 15 minutes [ICGR15]: 28%), who was successfully treated with a right hepatectomy, resulting in the preservation of the entire caudate lobe. After chemotherapy, all metastatic lesions shrunk, but his ICGR15 and indocyanine green clearance rate (ICGK) were 21% and 0.12%, respectively.…”