Direct hepatic vein anastomosis during hepatectomy for colorectal liver metastases

BACKGROUND: When the right and middle hepatic veins (RHV and MHV) and all the short hepatic veins are removed during resection of segments (S) 7 and 8 and part of S 5 and 6 including the caudate lobe, the remainder of S 5 and 6 shows congestion, so restoration of liver function may be delayed. METHODS: in 5 patients with hepatic metastases of colorectal carcinoma, which were in the region circumscribed by the RHV, MHV, and inferior vena cava, direct hepatic vein anastomosis was performed during hepatectomy. RESULTS: Hepatic vein reconstruction took 17 to 30 minutes to complete. All 5 patients had an uneventful postoperative course, and the anastomosis was patent at 1 month after operation. One patient died of recurrent carcinoma 6 months after operation. Four have remained alive and disease free for 12, 24, 40, and 61 months. CONCLUSION: Direct hepatic vein anastomosis is an option, which should be adopted in hepatectomy, especially in patients with carcinoma invading the major hepatic veins and short hepatic veins.