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Case Report
Tunnel hepatectomy: A review of the parenchymal-sparing technique in colorectal liver metastasis and operative video
1 Department of HPB Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
2 Department of Radiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Alexandre de Hemptinne
MD, Department of HPB Surgery, Cliniques Universitaires Saint-Luc, Brussels,
Belgium
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Article ID: 100133Z12AH2024
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de Hemptinne A, Salavracos M, Coubeau L. Tunnel hepatectomy: A review of the parenchymal-sparing technique in colorectal liver metastasis and operative video. J Case Rep Images Surg 2024;10(1):26–29.ABSTRACT
Introduction: Surgery of colorectal liver metastases (CRLM) has evolved over the past decades from an interest mainly focused on oncological margins to a new surgical policy known as parenchymal sparing hepatectomy (PSH). Contrary to anatomical resection (AR), this new approach combines the well-known issue of curative resections (R0 resections) in tumor removal with a new doctrine, reducing the unnecessary sacrifice of healthy parenchyma as much as possible (salvageability).
Case Report: We report the case of a 60-year-old man diagnosed with rectal adenocarcinoma accompanied by seven synchronous bilobar liver metastases, including two closely situated metastases. The first was located in liver segment VIII, whereas the second was positioned between segments VIII and IV, just beneath the middle hepatic vein (MHV). In order to resect these two lesions without sacrificing the middle hepatic vein and preserving as much hepatic parenchyma as possible, we have chosen a conservative resection approach, the tunnel hepatectomy (TH).
Conclusion: Parenchymal sparing hepatectomy is the recommended approach in CRLM disease. Beyond the need to ensure healthy oncological margins, every surgeon should pay special attention to preserving hepatic parenchyma. Therefore, 3D modeling of the liver and its lesions appear to be a great assistance before any sophisticated surgical intervention to ensure the most conservative surgery possible. And for patients with deep liver metastases having complex relationships, TH seems to be a suitable technique.
Keywords: Colorectal liver metastases, Parenchymal sparing hepatectomy, 3D liver modeling, Tunnel hepatectomy
SUPPORTING INFORMATION
Author Contributions
Alexandre de Hemptinne - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Mike Salavracos - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Laurent Coubeau - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2024 Alexandre de Hemptinne et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
