Extended Right Hepatectomy and Inferior Vena Cava Graft Replacement for En Bloc Resection of Hepatocellular Carcinoma with Cavo-Hepatic Venous Confluence Invasion

Tzedakis, Stylianos; Mimmo, Antonio; Robert, Anthony; Jeddou, Heithem; Dehlawi, Amar; Boudjéma, Karim

doi:10.1245/s10434-018-6665-5

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…To date, reports of combined liver and IVC resection for hepatic malignancy remain scarce because of the technical difficulty. Some sporadic case reports of successful combined liver and IVC resection for hepatocellular carcinoma ( 18 ) and intrahepatic cholangiocarcinoma ( 19 ), however, are found in the literature.…”

Section: Discussionmentioning

confidence: 99%

Resection and reconstruction of the largest abdominal vein system (the inferior vena cava, hepatic, and portal vein): a narrative review

Kaneko,

Hayashi,

Kazami

et al. 2024

Transl Gastroenterol Hepatol

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Background and Objective As tumors invade major abdominal veins, surgical procedures are transformed from simple and basic to complicated and challenging. In this narrative review, we focus on what is currently known and not known regarding the technical aspects of major abdominal venous resection and its reconstruction, patency, and oncologic benefit in a cross-cutting perspective. Methods A systematic literature search was performed in PubMed and Semantic Scholar from inception up to October 18, 2023. We reviewed 106 papers by title, abstract, and full text regarding resection or reconstruction of the inferior vena cava, hepatic vein confluence, portal vein (PV), and middle hepatic vein (MHV) tributaries in living donor liver transplantation (LDLT) in a cross-cutting perspective. Key Content and Findings The oncologic benefit of aggressive hepatic vein resection with suitable reconstruction against adenocarcinoma remains unclear, and further studies are required to clarify this point. A superior mesenteric/PV resection is now a universal, indispensable, and effective procedure for pancreatic ductal adenocarcinoma. Although many case series using tailor-made autologous venous grafts have been reported, not only size mismatch but also additional surgical incisions and a longer operation time remain obstacles for venous reconstruction. The use of autologous alternative tissue remains only an alternative procedure because the patency rate of customized tubular conduit type to interpose or replace the resected vein is not known. Unlike arterial replacement, venous replacement using synthetic vascular grafts is still rarely reported and there are several inherent limitations except for reconstruction of tributaries of MHV in LDLT. Conclusions Various approaches to abdominal vein resection and replacement or reconstruction are technically feasible with satisfactory results. Synthetic vascular grafts may be appropriate but have a certain rate of complications.

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Section: Discussionmentioning

confidence: 99%

Resection and reconstruction of the largest abdominal vein system (the inferior vena cava, hepatic, and portal vein): a narrative review

Kaneko,

Hayashi,

Kazami

et al. 2024

Transl Gastroenterol Hepatol

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“…Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide, and its incidence is increasing in many countries [1–4] . Patients with advanced HCC, especially those with inferior vena cava tumor thrombus (IVCTT), are considered to have an extremely poor prognosis, for which treatment with stereotactic body radiotherapy (SBRT) combined with molecularly targeted drugs has been proposed [5,6] . Sorafenib, a tyrosine kinase inhibitor and a molecularly targeted drug, is generally recommended for patients with advanced HCC, with an expected median survival benefit of nearly three months [7,8] .…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Patients with advanced HCC, especially those with inferior vena cava tumor thrombus (IVCTT), are considered to have an extremely poor prognosis, for which treatment with stereotactic body radiotherapy (SBRT) combined with molecularly targeted drugs has been proposed. [5,6] Sorafenib, a tyrosine kinase inhibitor and a molecularly targeted drug, is generally recommended for patients with advanced HCC, with an expected median survival benefit of nearly three months. [7,8] More effective local therapies are needed for patients with advanced HCC with IVCTT.…”

Section: Introductionmentioning

confidence: 99%

Successful management of the hepatocellular carcinoma with inferior vena cava tumor thrombus

Liu

Xie

et al. 2021

Medicine

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Rationale:Hepatocellular carcinoma (HCC) with inferior vena cava tumor thrombus (IVCTT) is traditionally considered an advanced-stage cancer with a poor prognosis. There is no standard treatment for patients diagnosed as HCC with IVCTT.Patient concerns:A 52-year-old man was admitted to our hospital because of suspected hepatic mass during a health examination.Diagnoses:Computed tomography (CT) showed a hepatic mass approximately 4.3 cm × 6.3 cm in size located in segment VII of the liver, with thrombus in the inferior vena cava. The mass exhibited a pattern of early enhancement and washout on contrast-enhanced CT. Alpha-fetoprotein was 614.1 ng/mL (normal value, <8 ng/mL). The preoperative diagnosis was HCC with IVCTT.Interventions:Two months after stereotactic body radiotherapy combined with sorafenib therapy, a planned open anatomical resection of the right posterior lobe of the liver was performed.Outcomes:The patient is alive without disease 12 months after surgery, and the level of alpha-fetoprotein is normal.Lessons:The patient diagnosed as HCC with IVCTT was successfully treated by stereotactic body radiotherapy combined with molecularly targeted drugs followed by surgical treatment. If confirmed in future studies, this would suggest a promising strategy for the management of HCC with IVCTT.

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Combination Therapy Consisting of Transarterial Chemoembolization, Lenvatinib, and Programmed Cell Death Protein 1 Blockade for Hepatocellular Carcinoma with Inferior Vena Cava Tumor Thrombus: A Case Series Study and Literature Review

Fu,

Li,

Liu

et al. 2024

Oncol Res Treat

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Introduction: Patients with hepatocellular carcinoma (HCC) and inferior vena cava carcinoma tumor thrombus (IVCTT) have poor prognosis. Combination therapy involving blockade of programmed cell death protein 1 (PD-1) and tyrosine kinase inhibitors (TKIs) is an efficient treatment strategy for advanced HCC. However, surgical treatment after a combination of systemic therapy and transarterial chemoembolization (TACE) for HCC with IVCTT has not been widely reported, and the efficacy and safety of this treatment have not been studied. Methods: In the 21 cases reported herein, the patients were treated with TACE, lenvatinib, and PD-1 blockade. The treatment responses, progression-free survival (PFS), overall survival (OS), disease control rate, and toxicities were evaluated, and the related literature was reviewed. Results: The overall response and disease control rates were 66.7% and 85.7%, respectively. The median PFS time was 16.0 months, with a 1-year PFS rate of 55.60%. The median OS was not reached, with a 1-year OS rate of 66.70%. Four patients underwent hepatectomy without serious complications and survived for 29.1, 24.7, 14.2, and 13.8 months. Three patients survived tumor-free, and one patient experienced intrahepatic recurrence. Pathological complete response and major pathological responses were observed in one and three patients, respectively. Treatment-related adverse events of any grade occurred in of 8/9 patients (88.9%), and grade 3 treatment-related adverse events occurred in one patient. Conclusion: The combination of TACE, lenvatinib, and PD-1 is effective for HCC with IVCTT and has acceptable adverse effects.

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Extended Right Hepatectomy and Inferior Vena Cava Graft Replacement for En Bloc Resection of Hepatocellular Carcinoma with Cavo-Hepatic Venous Confluence Invasion

Abstract: Liver surgery with complex vascular resections for HCC with major vascular invasion should be considered a valid therapeutic option in high-volume hepatobiliary centers.

Cited by 3 publications

References 5 publications

Resection and reconstruction of the largest abdominal vein system (the inferior vena cava, hepatic, and portal vein): a narrative review

Resection and reconstruction of the largest abdominal vein system (the inferior vena cava, hepatic, and portal vein): a narrative review

Successful management of the hepatocellular carcinoma with inferior vena cava tumor thrombus

Combination Therapy Consisting of Transarterial Chemoembolization, Lenvatinib, and Programmed Cell Death Protein 1 Blockade for Hepatocellular Carcinoma with Inferior Vena Cava Tumor Thrombus: A Case Series Study and Literature Review

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