Ex Situ Hepatectomy and Autologous Liver Transplantation for Recurrent Pheochromocytoma invading the Retrohepatic Vena Cava: Case report.

INTRODUCTION

Tumors involving the hepatic venous confluence and the retrohepatic inferior vena cava (IVC) remain among the most formidable challenges in hepatobiliary surgery. Conventional in situ resection is often unfeasible due to limited vascular control and the high risk of massive bleeding or incomplete oncologic margins. Liver autotransplantation with ex situ hepatectomyhas emerged as an advanced surgical strategy that allows total vascular exclusion, hypothermic perfusion, and complex vascular reconstruction on the back table. Recurrent pheochromocytoma with major vascular invasion is rare, but when present, demands aggressive management in highly specialized centers to achieve radical resection and long-term disease control.

CASE REPORT: A 64-year-old woman presented with recurrent pheochromocytoma infiltrating the retrohepatic IVC. She had undergone right adrenalectomy 4 years earlier. Due to the impossibility of achieving an R0 resection with standard techniques, liver autotransplantation was performed. The procedure consisted of total hepatectomy under veno-venous bypass, hypothermic perfusion with preservation solution, ex situ caudate lobe resection, and en bloc resection of the retrohepatic inferior vena cava (IVC). On the back table, the hepatic venous outflow was reconstructed, and a neocava was created using deceased-donor iliac vein allografts before liver autotransplantation. Total ischemia time was 191 minutes, and operative time reached 770 minutes. Postoperative complications-hypernatremia, bronchopneumonia, and catheter-related jugular vein thrombosis-were successfully managed in the intensive care unit. Postoperative liver function was preserved, and the patient was discharged home on postoperative day 24.

CONCLUSION

In experienced transplant centers, liver autotransplantation with ex situ hepatectomy is a feasible and effective strategy for selected patients with complex vascular tumor recurrence, facilitating radical resection, vascular reconstruction, and favorable postoperative outcomes.