Introduction : For hepatic tumors invading or adherent to the retrohepatic inferior vena cava (IVC), hepatectomy combined with IVC resection is required to get a R0 resection. The techniques for IVC reconstruction after resection are usually dictated by the degree of the IVC involvement by the tumor. Direct repair, patch graft and conduit graft are among the choices. The authors report here a patient who underwent hepatectomy combined with IVC resection for double HCC’s that one was located at the inferior tip of segment 4 and the other at the caudate lobe, encircling almost 180 degree of the retorhepatic IVC.

Methods : Left hemihepatectomy, caudate lobectomy and en bloc IVC tangential excision was performed and got a tumor-free resection margin. The operative planes between the caudate lobe (or IVC ligament) and the retroperitoneum (diaphragm, crural ligament and prevertebral fascia) as well as the caudate lobe and IVC should be clearly secured to get a sound IVC margins in this complex operation. The defect in the postero-left lateral IVC wall after resection was patch repaired with Bovine pericardium. The details of the operative procedure are going to be presented with a video.

Results : The operation took 395 minutes. Intraoperative blood loss was 1,000 g. No blood product was given perioperatively. Clavien grade 1 complication (pleural effusion and atelectasis) developed. The patient was discharged 14 days after the operation.

Conclusions : Through a well-planned surgery based on preoperative imaging studies, retrohepatic IVC resection and repair combined with partial hepatectomy can be performed safely with adequate oncologic outcome.