Journal of Surgical Oncology 2007;96:73–76 HOW I DO IT Resection and Reconstruction of Retrohepatic Vena Cava Without Venous Graft During Major Hepatectomies MARCEL AUTRAN C. MACHADO, MD,* PAULO HERMAN, MD, TELESFORO BACCHELLA, MD, AND MARCEL C.C. MACHADO, MD, FACS Department of Gastroenterology, University of Sa ˜o Paulo, Sa ˜o Paulo, Brazil Background: Progress in liver surgery has enabled hepatectomy with concomitant venous resection for liver malignancies involving the inferior vena cava (IVC). The authors describe an alternative technique for IVC reconstruction without the need of graft. Methods: Parenchymal transection is performed from anterior surface of the liver down to the anterior or left lateral surface of the IVC using combination of two techniques reported elsewhere. IVC is clamped above and below the tumor and the liver in continuity with an invaded segment of IVC is removed en bloc. A transverse anastomosis of IVC is performed starting with running suture on the posterior wall followed by the anterior wall. Results: This approach has been successfully employed in eight consecutive patients with IVC involvement. The procedures performed were 5 right hepatectomies, 1 right posterior sectionectomy, 1 right trisectionectomy, and 1 left trisectionectomy. Two patients needed total vascular exclusion (TVE) for 11 and 10 min, respectively. Blood transfusion was necessary in three patients. Pathologic surgical margins were free in all cases. No postoperative mortality was observed. Conclusion: This technique of IVC reconstruction precludes the use of graft and minimizes the use of TVE decreasing ischemic damage to the remnant liver. J. Surg. Oncol. 2007;96:73–76. ß 2007 Wiley-Liss, Inc. KEY WORDS: liver; inferior vena cava; technique; anatomy; hepatectomy INTRODUCTION Until last decade, liver tumor with concomitant venous involvement has been considered a contraindication for liver resection. Recently, progress in liver surgical techniques allows resection in selected patients with liver malignancies involving the inferior vena cava (IVC) [1–7]. In patients with liver tumors and retrohepatic vena cava invasion, the usual approach is to perform a posterior and lateral dissection of the IVC after the complete mobilization of right liver. Another option is to perform a liver hanging maneuver [8] with exposure of the IVC anterior aspect. However, when tumor invades IVC anterior aspect those techniques are not suitable when the retrohepatic avascular plane anterior to the IVC surface is occupied by the tumor. In this situation, the surgeon is not capable to encompass the IVC with the postero-lateral approach and total vascular occlusion [9] becomes mandatory. The authors report their experience with IVC resection and reconstruction during major hepatectomies and *Correspondence to: Marcel Autran C. Machado, MD, Rua Evangelista Rodrigues 407-05463-000, Sa ˜o Paulo, Brazil. Fax: 55-11-3285-2640. E-mail: dr@drmarcel.com.br Received 27 November 2006; Accepted 8 December 2006 DOI 10.1002/jso.20762 Published online 7 March 2007 in Wiley InterScience (www.interscience.wiley.com). ß 2007 Wiley-Liss, Inc.