Right hemicolectomy is the more difficult surgery in hepatobiliary surgery. It is a dangerous surgery due to the removal of a large portion of the liver, the high surgical risk, the high bleeding during the surgery, and the need to block the hepatic portal blood flow, which in turn affects the function of the liver and causes danger. In contrast, the extended right hemicolectomy is based on the right hemicolectomy with partial resection of the left liver and caudate lobe, which is even more extensive and is the most difficult surgery in hepatectomy, requiring comprehensive evaluation, thorough planning and superior technique. Recently, the author completed a case of “extended right hepatectomy, resection of right branch of portal vein and removal of cancer thrombus” (resection of right hepatic half, part of left inner lobe, right segment of caudate lobe and right branch of portal vein). The patient is described as follows: Huang Gang, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Guangzhou Medical University
Patient Liang Moumou, male, 48 years old. He was admitted to the hospital on March 1, 2013 due to “right upper abdomen distension, pain and other discomfort for more than 2 months, 1 month after intervention”. The patient was found to be positive for hepatitis B virus for more than 10 years without any discomfort, regular checkups, or antiviral treatment.
The patient came to our hospital more than 2 months ago with no obvious cause of right upper abdominal distension and discomfort, with occasional pain. After CT examination, he was diagnosed with giant hepatocellular carcinoma of the right liver and cancerous thrombus of the right branch of portal vein. Due to the obstruction of the right branch of portal vein, the left liver was compensated with enlargement, and he was admitted to the hospital for interventional treatment and discharged successfully. Now he came to the hospital for review and further treatment. After hospitalization, it was found that the patient had a huge hepatocellular carcinoma of the right liver (150*130mm), the right branch of the portal vein was completely obstructed by the cancer thrombus and the right branch of the portal vein, the cancer invaded the right segment of the caudate lobe and part of the left inner lobe of the liver, the volume of the left liver was significantly enlarged, and the transaminases were elevated. After comprehensive and meticulous analysis and preoperative management, it was decided to perform an extended right hepatectomy and resection of the right branch of the portal vein with cancer thrombus removal (resection of the right hepatic half, part of the left inner lobe, the right segment of the caudate lobe and the right branch of the portal vein) (huge surgery).
An enlarged right hemicolectomy was performed under general anesthesia in early March 2013. Intraoperative findings: clear yellowish ascites, moderate cirrhosis, cirrhotic nodules on the margins and surface of the liver, huge hepatocellular carcinoma of the right liver (150*130 mm), cancerous thrombus of the right branch of the portal vein and complete obstruction of the right branch of the portal vein, cancerous invasion of the right segment of the caudate lobe and part of the left inner lobe of the liver, compensatory hypertrophy of the left liver volume and esophagogastric fundic varices. The right half of the liver, part of the left inner lobe, the right segment of the caudate lobe and the right branch of the portal vein were successfully resected. The patient recovered better and faster due to precise and meticulous surgery with little damage and without blocking the hepatic hilum as in conventional hepatectomy.