Vascular reconstruction combined with liver resection for malignant tumours

Abstract

Liver resection with combined vascular resection and reconstruction can be performed in selected patients with acceptable morbidity and mortality. The lack of therapeutic alternatives and the poor outcome of non-operative management seem to justify this approach. The identification of risk factors should help improve patient selection and postoperative outcome as well as facilitate objective risk communication with surgical candidates.

Retrocaval liver lifting maneuver and modifications of total hepatic vascular exclusion for liver tumor resection

“…While the mean durations of THVE were 29 min to 78 min in the reports from very experienced institutes [1,2,7,8] , the mean THVE duration in the present study was only 13.4 ± 8.4 min. The mortality rates of hepatectomy with IVC resection were 4.5% to 25% in the previous reports [1][2][3][4]8,10,11,15] . In particular, the morbidity and mortality rates were quite high when standard THVE was applied frequently, even when hypothermic perfusion was used to attenuate the ischemic liver damage.…”

“…Then, the involved IVC wall (white arrowhead in B) and the liver was resected en-bloc under modified THVE; C (intraoperative image): The involved IVC wall was cut away with scissors (arrow) between the oblique cranial (blue arrowhead) and caudal (purple arrowhead) cross-clamps; D (illustration) and E (intraoperative image): The large cut orifice of IVC was reconstructed with IMV patch graft (black arrowhead). See Figure 1D particularly when compared to those reported by other studies [1][2][3]8,10,11] . To date, only a limited number of studies of THVE for resection of liver tumors involving IVC are present in the publicly available literature, probably because the number of experiences in individual institutes has been small.…”

“…Minimizing the duration and extent of exclusion is key to increasing the safety of THVE [2] . To this end, the present study highlights the feasibility of three technical modifications of THVE.…”

“…Despite recent advances in liver surgery, resection for tumors involving inferior vena cava (IVC) is still challenging [1][2][3][4] . This situation requires total hepatic vascular exclusion (THVE) for combined resection of the IVC.…”

“…Long occlusion time is one of the most significant hazards of operative morbidity and mortality after hepatectomy with THVE [2] . There is no doubt about the importance of minimizing duration of THVE to reduce ischemic damage of the liver.…”