PMC7132119_01
Enhanced abdominal CT and 3-dimensional (3D) imagings analysis. a: the lesion invaded the root of right hepatic vein; b: invaded the root of left hepatic vein; c: invaded the root of right hepatic vein branch (ventral/dorsal branches) and the retrohepatic anterior wall of IVC; d: invaded the root of left hepatic vein (3D image); e: the lesion was adjacent to the porta hepatis (3D image); f: the volume of the left liver section (3D image).
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The hepatic veins were invaded (Fig. 1). The circumferential diameter of the root was involved for more than 3/4 (Fig. 1a/c). The retrohepatic anterior wall of inferior vena cava (IVC) was also invaded (Fig. 1b/d).
PMC7132119_02
PMC7132119_03
Operative procedure: a: separated the branches of HA/HV/BD, dissected the suprahepatic and subhepatic IVC; b: slit the liver parenchyma based on the anterior approach, and repaired the left hepatic vein during resection; c: dissected down to the invaded roots of right hepatic vein (ventral/dorsal branches) and retrohepatic IVC; d: resected the AE lesion in vitro; e: the remnant right liver after resection of the mass; f: reconstructed the outflow of right liver with a wide mouth anastomosis using allogeneic veins (anterior wall); g: reconstructed the outflow of right liver with a wide mouth anastomosis using allogeneic veins (posterior wall); h: auxiliary right autologous liver transplantation.
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The hepatic veins and the IVC were then dissected (Fig. 2a). The root of the left HV was exposed to show the lesion invasion for about 3 cm length (Fig. 2b). The roots of the right HV (ventral/dorsal branches) were shown to be invaded (Fig. 2c).
PMC7132119_04
Specimen and images during postoperative follow-up a: the specimen; b: the ventral/dorsal branches and wide mouth anastomosis (1 month after operation); c: the branches of left HV (1 month after operation); d: MRCP (1 month after operation).
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The resected specimen was sent for pathological examination (Fig. 3a).
PMC7132119_05
a: CT scan (6 months after operation); b: MRCP (6 months after operation).
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After 6 months, CT scan and MRI indicated no hepatic nodules and there was no liver congestion (Fig. 4).