Retrocaval liver lifting maneuver and modifications of total hepatic vascular exclusion for liver tumor resection

Table 1 Surgical procedures

Case No.	Diagnosis	No. of tumor	Size of the largest tumor, cm	THVE and modifications	THVE duration, min	Hepatectomy	Vascular reconstruction procedures	Outcome
1	HCC	1	20.0	Standard with switching1	5	Extended right hepatectomy	Direct suture of IVC	Alive without disease, 60 mo postoperative
2	Liver metastasis	1	20.0	Standard with switching1	9	Extended right hepatectomy	IMV patch for HV, Direct suture of IVC	Alive with disease, 17 mo postoperative
3	Liver metastasis	2	9.0	Standard with switching1	23	Extended right hepatectomy	IMV patch for HV and IVC	Alive with disease, 10 mo postoperative
4	Liver metastasis	1	6.0	Oblique2 (right)	26	Right hepatectomy	IMV patch graft for IVC	Died of disease, 27 mo postoperative
5	Liver metastasis	4	2.5	Oblique2 (right)	20	Partial resection	IMV patch graft for IVC and HV	Alive without disease, 15 mo postoperative
6	Liver metastasis	10	18.0	Oblique2 (right)	7	Right hepatectomy, partial resection	Direct suture of IVC	Died of disease, 8 mo postoperative
7	Liver metastasis	15	5.5	Oblique2 (right)	7	Extended anterior sectionectomy, partial resection	Direct suture of IVC	Died of disease, 9 mo postoperative
8	Liver metastasis	9	5.5	Oblique2 (left)	10	Segmentectomy, partial resection	Direct suture of IVC and HVs	Alive without disease, 13 mo postoperative

¹Switching the cross-clamp;

²Oblique cross-clamping. IMV: Inferior mesenteric vein; IVC: Inferior vena cava; HVs: Hepatic veins; THVE: Total hepatic vascular exclusion.

Table 2 Operative parameters and postoperative course of 8 patients

Parameters	Values or number of patients
Operation time	482 ± 108 min
Blood loss	1778 ± 1233 mL
THVE duration	13.4 ± 8.4 min
Postoperative liver function
TB (mg/dL)
Maximum	2.01 (0.98-4.4)
POD7	1.08 (0.75-1.86)
AST (IU/L)
Maximum	513 (238-1058)
POD7	30 (20-41)
ALT (IU/L)
Maximum	319 (179-824)
POD7	64 (36-115)
PT (%)
Minimum	64.4 (55.3-88.8)
POD7	88.1 (61.6-107.8)
Complications
Clavien-Dindo classification
I	2
II	1
≥ III	0
Operative mortality	0
Hospital stay (d)	15 (12-24)

AST: Aspartate amino transferase; PT: Prothrombin time; TB: Total bilirubin; ALT: Aspartate alanine aminotransferase; THVE: Total hepatic vascular exclusion.