Approaches to reconstruction of inferior vena cava by ex vivo liver resection and autotransplantation in 114 patients with hepatic alveolar echinococcosis

Abstract

BACKGROUND Hepatic alveolar echinococcosis (AE) is most commonly found in retrohepatic inferior vena cava (RHIVC). Ex vivo liver resection and autotransplantation (ELRA) can better realize the radical resection of end-stage hepatic AE with severely compromised hepatocaval confluences, and reconstruction of the affected vessels. Currently, there is a scarcity of information regarding RHIVC reconstruction in ELRA. AIM To propose reasonable RHICV reconstruction strategies for ex vivo liver resection and autotransplantation. METHODS We retrospectively summarized the clinical data of 114 patients diagnosed with hepatic AE who treated by ELRA in our department. A total of 114 patients were divided into three groups according to the different reconstruction methods of RHIVC: Group A with original RHIVC being repaired and reconstructed ( n = 64), group B with RHIVC being replaced ( n = 43), and group C with RHIVC being resected without reconstruction ( n = 7). The clinical data of patients, including the operation time, anhepatic phase, intraoperative blood loss, complications and postoperative hospital stay, were analyzed and the patients were routinely followed up. The normally distributed continuous variables were expressed as means ± SD, whereas the abnormally distributed ones were expressed as median and analyzed by analysis of variance. Survival curve was plotted by the Kaplan-Meier method. RESULTS All patients were routinely followed up for a median duration of 52 (range, 12-125) mo. The 30 d mortality rate was 7.0% (8/114) and 7 patients died within 90 d. Among all subjects, the inferior vena cava (IVC)-related complication rates were 17.5% (11/63) in group A and 16.3% (7/43) in group B. IVC stenosis was found in 12 patients (10.5%), whereas thrombus was formed in 6 patients (5.3%). Twenty-two patients had grade III or higher complications, with the complication rates being 17.2%, 16.3%, and 57.1% in the three groups. The average postoperative hospital stay in the three groups was 32.3 ± 19.8, 26.7 ± 18.2, and 51.3 ± 29.4 d ( P = 0.03), respectively. CONCLUSION ELRA can be considered a safe and feasible option for end-stage hepatic AE patients with RHIVC infiltration. The RHIVC reconstruction methods should be selected appropriately depending on the defect degree of AE lesions in IVC lumen. The RHIVC resection without any reconstruction method should be considered with caution.

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

“…Several urologic surgeons recommended ePTFE use rather than Dacron ( 84 , 90 ). Other follow-up outcomes of 38 ePTFE synthetic vascular grafts reconstruction for IVC in 114 alveolar echinococcosis patients showed 16.3% Clavien-Dindo Grade IIIa or higher ( 91 ), and 11.6% IVC thrombosis, but a favorable survival rate of more than 95% at 2 years ( 92 ).…”

Silent Rupture in the Inferior Vena Cava: A Complication Not to Be Ignored in the Presence of a Segment I Hydatid Cyst

“…Prosthetic reconstruction must be systematically anticipated and depends on preoperative reconstruction and intraoperative data, which allow judging the percentage of the circumference of the vena cava affected. Replacement appears mandatory when the invasion exceeds 180° [ 13 ]. This particularity of segment I hydatid cysts in the absence of codified consensus complicates the task of conventional postoperative follow-up [ 14 ], to which the complications of vena cava replacement are added [ 13 , 15 ].…”

“…Replacement appears mandatory when the invasion exceeds 180° [ 13 ]. This particularity of segment I hydatid cysts in the absence of codified consensus complicates the task of conventional postoperative follow-up [ 14 ], to which the complications of vena cava replacement are added [ 13 , 15 ].…”

Transplantation techniques for liver resections in children

“…Тем не менее большой риск осложнений, связанных прежде всего с ПН, не позволял внедрить эти методы в повседневную практику [12]. Даль нейшее развитие хирургических технологий и анестезиологического пособия привело к сопоставимым результатам анатомической обширной резекции и РП с применением ТТ, 90-дневная летальность составила до 14% [13]. Аналогичные тенденции можно проследить и в развитии РП с реконструкцией ВВ или ПА с постепенным уменьшением частоты летальных исходов до значений, сопоставимых с обширной РП [8].…”