Successful Redo Right Hepatic Vein Reconstruction for Recurrent Colorectal Liver Metastases After Triple Hepatic Vein Resection: Implications of Late-Onset Venous Stenosis.

backgroundIn colorectal liver metastases deemed unresectable, advances in chemotherapy and venous reconstruction techniques have enabled resection in selected patients. PATIENT AND

methodsWe experienced a case of late stenosis in a reconstructed hepatic vein that had remained patent for 8 years. To further investigate this issue, we analyzed the causes and timing of venous stenosis in 72 reconstructed veins from 66 cases performed at our institution between 2004 and 2025.

resultsA 49-year-old woman with initially unresectable rectal cancer and multiple liver metastases involving all three major hepatic veins underwent extended hepatectomy with triple hepatic vein resection and reconstruction after chemotherapy, and 8 years later, severe stenosis of the reconstructed right hepatic vein (RHV) was detected without definitive evidence of recurrence on imaging. Redo RHV resection and reconstruction using a right internal jugular vein graft were performed, and pathological examination confirmed tumor recurrence. Among the 72 reconstructed veins, stenosis occurred in 19, with 14 being due to technical factors unrelated to tumor and 5 associated with tumor recurrence. All technical stenoses occurred within 6 months, while all late stenoses were attributable to tumor recurrence.

conclusionsLate venous stenosis after hepatic vein reconstruction should raise suspicion of tumor recurrence. Redo reconstruction is feasible in selected patients.