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Right Hemihepatectomy for Metastatic Cloacogenic Carcinoma using the Staple Technique

¹ UPMC Liver Cancer Center, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
² UPMC Liver Cancer Center, Kaufmann Medical Building, Suite 300, 3471 Fifth Ave, Pittsburgh, PA 15213, USA

Correspondence: Address correspondence and reprint requests to: David A. Geller; E-mail: gellerda{at}upmc.edu

Introduction: The role of vascular stapling devices in major hepatic resections has extended beyond control of inflow and outflow vessels, to application in hepatic parenchymal transection. We report use of stapling device in a right hemihepatectomy for a solitary 8 cm metastasis from a cloacogenic anal canal carcinoma in a 69 year old female. She underwent Nigro protocol for treatment of the primary, and follow-up biopsy showed no residual disease in the anal canal.

Methods: The right hepatic vein was divided outside the liver with US Surgical Endo GIATM vascular stapler after division of the short hepatic veins. Following ligation of the right hepatic artery, the extra-hepatic right portal vein and right hepatic duct were separately divided with the vascular stapler, staying to the right side of the gallbladder fossa. After intra-operative ultrasound to delineate the transection plane, the liver capsule was divided with electrocautery to a depth of one cm. The hepatic parenchymal slice was accomplished with sequential application of the Ethicon EZ45TM linear stapler, facilitated by pre-tunneling with a blunt Kelly clamp.

Results: Estimated blood loss was 75 mL. No peri-operative blood transfusion was required, and there was no post-operative bile leak. Pringle clamp time was 5 minutes. Final pathological assessment confirmed tumor-free margins. The patient was discharged home on POD#5. Follow-up CT scan at 12 months showed no evidence of recurrence in the liver, however subsequent surveillance demonstrated pulmonary recurrence.

Conclusion: Stapled right hemihepatectomy technique is a safe, rapid, and hemostatic method of dividing the liver parenchyma.