• Yuzo Yamamoto.
• Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan. yamamoto-kyt@umin.ac.jp
• J Hepatobiliary Pancreat Sci. 2013 Mar 1; 20 (3): 313-23.

BackgroundFor patients with bulky liver tumors that have invaded all three hepatic veins at the hepatic venous confluence to the inferior vena cava (IVC), reconstruction of at least one hepatic vein outlet to the IVC is necessary.MethodsTo effectively treat these tumors, we performed 7 ante-situm liver resections. The ante-situm position provides surgeons with excellent visualization of the anatomical structures that should be maintained in the remnant liver. In addition, replacement of the involved IVC by a ringed expanded polytetrafluoroethylene (ePTFE) graft can be safely completed.ResultsBecause of the far-advanced malignancies of our 7 patients, the survival periods after surgery were limited, but the survival benefits of the procedure were not disappointing. From what has been reported in the literature, the survival periods in our patients appear to justify the employment of the procedure even when compared with survivals in patients who have less complex tumor extensions.ConclusionBecause of the complexity of this procedure, a team of surgeons familiar with liver surgery and liver transplantation in a specialized hepatobiliary center is required. However, we anticipate that this procedure will be feasible and justified for selected patients in whom tumor invasion at the confluence of all three hepatic veins and the IVC is too extensive to treat with other surgical procedures.

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