Retrohepatic vena cava deroofing in living donor liver transplantation for caudate hepatocellular carcinoma

摘要

The  removal  of  tumor  together  with  the  native liver in living donor liver transplantation for hepatocellular carcinoma is challenged by a very close resection margin if the  tumor  abuts  the  inferior  vena  cava.  This  is  in  contrast to  typical  deceased  donor  liver  transplantation  where the  entire  retrohepatic  inferior  vena  cava  is  included  in total  hepatectomy.  Here  we  report  a  case  of  deroofing  the retrohepatic vena cava in living donor liver transplantation for  caudate  hepatocellular  carcinoma.  In  order  to  ensure clear resection margins, the anterior portion of the inferior vena cava was included. The right liver graft was inset into a Dacron vascular graft on the back table and the composite graft was then implanted to the recipient inferior vena cava. Using  this  technique,  we  observed  the  no-touch  technique in tumor removal, hence minimizing the chance of positive resection margin as well as the chance of shedding of tumor cells during manipulation in operation.