Left hepatectomy extended to paracaval segment and anterior vena cava wall, with autologous venous graft reconstruction of middle hepatic vein under veno-venous bypass and "in situ" hypothermic liver perfusion: a surgical technique.

Surgical resection is the gold standard for the treatment of intrahepatic cholangiocarcinoma, whenever possible. In selected patients with involvement of the inferior vena cava, the hepatic veins or both, an aggressive surgery requiring vascular resection-reconstruction can be safely performed in experienced hands. Different approaches, including "ex situ", "ante situm" and "in situ" liver resection with or without the use of veno-venous bypass or cold liver perfusion can be used. We present the case of a 70-year-old woman presenting with a 5.5 cm mass located in the segment I compatible with an intrahepatic cholangiocarcinoma. A left hepatectomy extended to the segment I, right paracaval portion along with the resection of the anterior wall of the vena cava and the middle hepatic vein, together with its subsequent reconstruction using the autologous left branch of the portal vein was performed using a veno-venous bypass and hypothermic "in situ" liver perfusion. Major liver resections with vascular reconstructions that require more than 60 minutes of clamping and veno-venous bypass can be accomplished more safely using "in situ" cooling of the liver. The postoperative course was characterized by mild hepatic failure and the patient was discharged on postoperative day 20. In the five years of follow-up, the patient was in good clinical condition and disease-free, but in 2023, she passed away for a disease recurrence.