PMC9513360_01
Preoperative CT images of case 1: unenhanced phase (A), arterial phase (B), and venous phase (C); preoperative CT images of case 2: unenhanced phase (D), arterial phase (E), and venous phase (F); preoperative CT images of case 3: unenhanced phase (G), arterial phase (H), and venous phase (I); inside the yellow circle is the portal vein tumor thrombus.
fsurg-09-928452-g001.jpg
PMC9513360_03_fsurg-09-928452-g001.jpg
F1
The enhanced CT scans suggested the following: diffuse right liver cancer with tumor thrombus formation in the main portal vein (MPV) and left and right branches; the tumor was mainly located in the right lobe and had a maximum size of 8.8 cm; and liver cirrhosis with portal hypertension (Figures 1G-I).
PMC9513360_02
Preoperative CT images of case 1: unenhanced phase (A), arterial phase (B), and venous phase (C); preoperative CT images of case 2: unenhanced phase (D), arterial phase (E), and venous phase (F); preoperative CT images of case 3: unenhanced phase (G), arterial phase (H), and venous phase (I); inside the yellow circle is the portal vein tumor thrombus.
fsurg-09-928452-g001.jpg
PMC9513360_03_fsurg-09-928452-g001.jpg
F1
The enhanced CT scans suggested the following: diffuse right liver cancer with tumor thrombus formation in the main portal vein (MPV) and left and right branches; the tumor was mainly located in the right lobe and had a maximum size of 8.8 cm; and liver cirrhosis with portal hypertension (Figures 1G-I).
PMC9513360_03
Preoperative CT images of case 1: unenhanced phase (A), arterial phase (B), and venous phase (C); preoperative CT images of case 2: unenhanced phase (D), arterial phase (E), and venous phase (F); preoperative CT images of case 3: unenhanced phase (G), arterial phase (H), and venous phase (I); inside the yellow circle is the portal vein tumor thrombus.
fsurg-09-928452-g001.jpg
PMC9513360_03_fsurg-09-928452-g001.jpg
F1
The enhanced CT scans suggested the following: diffuse right liver cancer with tumor thrombus formation in the main portal vein (MPV) and left and right branches; the tumor was mainly located in the right lobe and had a maximum size of 8.8 cm; and liver cirrhosis with portal hypertension (Figures 1G-I).
(A) Anatomical separation showing the LPV, RPV, and MPV. (B) Blocking the blood flow of the LPV, RPV, and PV and removing the tumor thrombus in the portal vein (PVTT). (C) Flushing out possible residual tumor thrombi by releasing MPV blood flow. (D) Ligation of the right portal vein stump. (E) Separation of the left and right liver parenchyma. (F) Completion of the CLAPT procedure. (G) Anatomical separation showing the LPV, RPV, and MPV. (H) Cutting the portal vein to remove the tumor thrombus. (I) Ligation of the RPV stump. (J) Separation of the left and right liver parenchyma. (K) Photograph of the operation completed.
fsurg-09-928452-g002.jpg
PMC9513360_03_fsurg-09-928452-g002.jpg
F2
The RPV distant to the bifurcation, the left portal vein (LPV), and the MPV located distal to the PVTT were occluded by vascular clip (Figure 2G). The PVTT in the RPV or MPV was then removed from the opening, and the possible residual tumor thrombus was flushed with portal blood flow by releasing the vaso-occlusive band of the MPV (Figure 2H). The right branch of the portal vein was disconnected, and the broken end was ligated (Figures 2I,J). The liver was split into the root of the proximal middle hepatic vein and in front of the inferior vena cava (Figure 2K). A brief operation diagram is shown in Figures 2A-F.