Temporary caval occlusion technique during right divisional hepatectomy for massive hepatocellular carcinoma with caudal vena cava compression/involvement in dogs.

Abstract

Objective: To describe the perioperative and long-term outcomes of dogs with massive hepatocellular carcinoma (HCC) in the right hepatic division causing compression or involvement of the caudal vena cava (CVC) treated with right divisional hepatectomy using temporary caval occlusion (TCO).

Study design: Retrospective case series.

Animals: Nineteen client-owned dogs.

Methods: Medical records were reviewed. Data collected included signalment, preoperative imaging findings, operative details, adjunct procedures, transfusion requirements, histopathological diagnosis and surgical margin status, perioperative complications, and survival to discharge. Long-term outcome information was obtained from recheck examinations when available and from telephone interviews with referring veterinarians and/or owners.

Results: Right divisional hepatectomy with TCO was completed in all dogs; a Pringle maneuver was used in two of 19 dogs. Median TCO duration was 17.6 min (range, 7.0-25.7) and median operative time was 82 min (range, 69-127). Primary suture repair of the CVC was required in six of 19 dogs. R0 resection was achieved in 14 of 19 dogs. One dog died on postoperative day 2; 18/19 dogs were discharged. Of these dogs, seven were alive without reported recurrence or intrahepatic metastasis at the last follow up, 95-1355 days after surgery, whereas 11 had died at a median of postoperative day 729 (range, 204-1154). Postoperative intrahepatic metastasis was suspected in two dogs.

Conclusion: Temporary caval occlusion-assisted right divisional hepatectomy provided venous control in selected dogs with massive right-sided HCC and compression or involvement of the CVC, with no intraoperative mortality, one in-hospital death, and postoperative complications in six of the 18 discharged dogs.

Clinical significance: Temporary caval occlusion facilitates controlled dissection of the right hepatic veins and repair of small caval defects when present.