This video illustrates the case of rectal cancer with extensive liver metastasis involving three hepatic veins. The patient was a 41-year-old woman who presented with rectal bleeding. Work-ups revealed non-obstructive rectal cancer with liver metastasis. Her liver metastases included 8 small superficial lesions and 2 large central lesions involving all of three hepatic veins. She received systemic chemotherapy with FOLFOXILI with Bevacizumab with excellent response. Thus, we planned extended left hepatectomy with hepatic vein reconstruction following preoperative portal vein embolization. The patient tolerated this complex liver operation and completed laparoscopic low anterior resection for the rectal primary lesion 4 weeks later.

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