Complete and partial replacement of the inferior vena cava with autologous peritoneum in cancer surgery

Balzan, Silvio Márcio Pegoraro; Gava, Vinícius Grando; Magalhães, Marcelo Arbo; Rieger, Alexandre; Roman, Luiz Inácio; Santos, Caroline Dos; Marins, Morgana Pizzolatti; Rabaioli, Bruna; Raupp, Isabela Terra; Kunzler, Vanessa Batistella

doi:10.1002/jso.26558

Cited by 4 publications

(6 citation statements)

References 9 publications

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“…Surgical resection with complete tumor clearance improves patient survival and is superior to palliative therapy with regard to long-term outcome in cases with locally advanced tumors [ 1 , 3 , 9 ]. As a result of improved operative techniques, venous resection is a feasible, standard procedure in high-volume centers [ 10 , 11 , 12 ]. The reconstruction techniques follow the principles of vascular surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The material is easily available, without a considerable increase of the operation time and additional surgical procedure as in case of harvesting another vessel like ovarian/spermatic, saphena, and left renal vein and there is no size limitation. Furthermore, the risk of infection is lower, PPP`s are less expensive and there is no need for postoperative anticoagulation as in the case of synthetic materials [ 5 , 11 , 13 , 14 ]. Given all these advantages, vascular reconstruction with peritoneal patches has gained more acceptance in the last decade.…”

Section: Discussionmentioning

confidence: 99%

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How we do it—the use of peritoneal patches for reconstruction of vena cava inferior and portal vein in hepatopancreatobiliary surgery

Radulova-Mauersberger

Distler

Riediger

et al. 2022

Langenbecks Arch Surg

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Purpose Extended resections in hepatopancreatobiliary (HPB) surgery frequently require vascular resection to obtain tumor clearance. The use of alloplastic grafts may increase postoperative morbidity due to septic or thrombotic complications. The use of suitable autologous venous interponates (internal jugular vein, great saphenous vein) is frequently associated with additional incisions. The aim of this study was to report on our experience with venous reconstruction using the introperative easily available parietal peritoneum, focusing on key technical aspects. Methods All patients who underwent HPB resections with venous reconstruction using peritoneal patches at our department between January 2017 and November 2021 were included in this retrospective analysis with median follow-up of 2 months (IQR: 1–8 months). We focused on technical aspects of the procedure and evaluated vascular patency and perioperative morbidity. Results Parietal peritoneum patches (PPPs) were applied for reconstruction of the inferior vena cava (IVC) (13 patients) and portal vein (PV) (4 patients) during major hepatic (n = 14) or pancreatic (n = 2) resections. There were no cases of postoperative bleeding due to anastomotic leakage. Following PV reconstruction, two patients showed postoperative vascular stenosis after severe pancreatitis with postoperative pancreatic fistula and bile leakage, respectively. In patients with reconstruction of the IVC, no relevant perioperative vascular complications occurred. Conclusions The use of a peritoneal patch for reconstruction of the IVC in HPB surgery is a feasible, effective, and low-cost alternative to alloplastic, xenogenous, or venous grafts. The graft can be easily harvested and tailored to the required size. More evidence is still needed to confirm the safety of this procedure for the portal vein regarding long-term results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

How we do it—the use of peritoneal patches for reconstruction of vena cava inferior and portal vein in hepatopancreatobiliary surgery

Radulova-Mauersberger

Distler

Riediger

et al. 2022

Langenbecks Arch Surg

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“…Despite the increasing number of vascular reconstructions in liver surgery, there are no specific guidelines or studies for anticoagulant strategies for vascular surgery in liver resection. However, there are some recommendations for anticoagulant prophylaxis after arterial reconstruction in general vascular surgery [136], experiences and recommendations for anticoagulation after orthotopic liver transplantation [137,138], and case reports about vascular reconstruction of the portal vein or reconstruction of the vena cava [109,113,139]. In addition, there are general guidelines for perioperative venous thromboembolism prophylaxis in general and visceral surgery [140].…”

Section: Anticoagulation Strategiesmentioning

confidence: 99%

“…Most authors apply heparin i.v. at doses between 3000 and 5000 IE before vascular clamping for vascular reconstruction [ 113 , 141 ]. According to the guidelines within our institution, no anticoagulation is administered before cava clamping or pedicle clamping for in- and outflow control during liver resection.…”

Section: Anticoagulation Strategiesmentioning

confidence: 99%

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Vascular surgery in liver resection

Radulova-Mauersberger

Weitz

Riediger

2021

Langenbecks Arch Surg

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Vascular surgery in liver resection is a standard part of liver transplantation, but is also used in oncological liver surgery. Malignant liver tumors with vascular involvement have a poor prognosis without resection. Surgery is currently the only treatment to provide long-term survival in advanced hepatic malignancy. Even though extended liver resections are increasingly performed, vascular involvement with need of vascular reconstruction is still considered a contraindication for surgery in many institutions. However, vascular resection and reconstruction in liver surgery—despite being complex procedures—are safely performed in specialized centers. The improvements of the postoperative results with reduced postoperative morbidity and mortality are a result of rising surgical and anesthesiological experience and advancements in multimodal treatment concepts with preconditioning measures regarding liver function and systemic treatment options. This review focuses on vascular surgery in oncological liver resections. Even though many surgical techniques were developed and are also used during liver transplantation, this special procedure is not particularly covered within this review article. We provide a summary of vascular reconstruction techniques in oncological liver surgery according to the literature and present also our own experience. We aim to outline the current advances and standards in extended surgical procedures for liver tumors with vascular involvement established in specialized centers, since curative resection improves long-term survival and shifts palliative concepts to curative therapy.

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Inferior vena cava reconstruction with non‐fascial autologous peritoneum: Retrospective study and literature review

Delcarro,

Coubeau

2024

World j. surg.

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BackgroundInferior vena cava (IVC) resection is essential for complete (R0) excision of some malignancies. However, the optimal material for IVC reconstruction remains unclear. Our objective is to demonstrate the efficacy, safety, and advantages of using Non‐Fascial Autologous Peritoneum (NFAP) for IVC reconstruction. To conduct a literature review of surgical strategies for tumors involving the IVC.MethodsWe reviewed all IVC reconstructions performed at our institution between 2015 and 2023. Preoperative, operative, postoperative, and follow‐up data were collected and analyzed.ResultsA total of 33 consecutive IVC reconstructions were identified: seven direct sutures, eight venous homografts (VH), and 18 NFAP. With regard to NFAP, eight tubular (mean length, 12.5 cm) and 10 patch (mean length, 7.9 cm) IVC reconstructions were performed. Resection was R0 in 89% of the cases. Two patients had Clavien–Dindo grade I complications, 2 grade II, 2 grade III and 2 grade V complications. The only graft‐related complication was a case of early partial thrombosis, which was conservatively treated. At a mean follow‐up of 25.9 months, graft patency was 100%. There were seven recurrences and six deaths. Mean overall survival (OS) was 23.4 months and mean disease‐free survival (DFS) was 14.4 months. According to our results, no statistically significant differences were found between NFAP and VH.ConclusionsNFAP is a safe and effective alternative for partial or complete IVC reconstruction and has many advantages over other techniques, including its lack of cost, wide and ready availability, extreme handiness, and versatility. Further comparative studies are required to determine the optimal technique for IVC reconstruction.

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Complete and partial replacement of the inferior vena cava with autologous peritoneum in cancer surgery

Cited by 4 publications

References 9 publications

How we do it—the use of peritoneal patches for reconstruction of vena cava inferior and portal vein in hepatopancreatobiliary surgery

How we do it—the use of peritoneal patches for reconstruction of vena cava inferior and portal vein in hepatopancreatobiliary surgery

Vascular surgery in liver resection

Inferior vena cava reconstruction with non‐fascial autologous peritoneum: Retrospective study and literature review

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