A Case of Simultaneous Multiple Liver Metastases from Rectal Cancer Resected with Caval Vein Replacement

We report a case of rectal cancer with synchronous multiple liver metastases invading to the inferior vena cava (IVC). The patient was a 61-year-old man. Abdominal CT showed multiple liver metastases in segments 1, 6, 7 and 8. Invasion of the IVC from the liver metastases was suspected from the caval venography findings. Extended right hepatic lobectomy and caudate lobectomy with resection and replacement of the IVC using Dacron with rings under the Biopump by total hepatic vascular exclusion (THVE) for the multiple liver metastases from the rectal cancer was conducted as the first operation. About one month later the second operation, a low anterior resection of the rectum, was performed. The patient is alive 2 years after surgery without any recurrence of rectal cancer. This case suggests the possibility and utility of the aggressive surgical method for the liver metastases from rectal cancer invading IVC, therefore we recommend the operation for such a case because of the improved quality of life (QOL) and prolonged survival of the patient.