Extent of pathologic invasion of the inferior vena cava in resected liver cancer compared with possible caval invasion diagnosed by preoperative images

Abstract

The extent of cancerous invasion of the inferior vena cava (IVC) determined from resected liver cancer was examined pathologically. Ten patients presenting with liver cancer (metastatic liver cancer, five patients; hepatocellular carcinoma, three; and cholangiocellular carcinoma, two) were diagnosed with positive IVC invasion using preoperative imaging techniques of extracorporeal ultrasonography, computed tomography, magnetic resonance imaging, and vena cavography. The diagnostic criterion for positive IVC invasion by preoperative imaging was longitudinal IVC compression measuring over 50 mm, or transverse IVC compression extending to more than half the circumference of the IVC, or the presence of lesions protruding into the IVC lumen, or the presence of developed collateral veins. All patients underwent combined resection of the IVC. However, pathology results revealed that four of the ten patients had no cancerous invasion of the IVC, and that the extent of invasion along both the longitudinal and transverse axes of the IVC was much smaller than the compression shown by imaging results. We believe that detailed preoperative assessment, using a more precise imaging technique, as well as further intraoperative examination, is required to predict the full pathological extent of cancerous invasion of the IVC.

Liver resection for advanced or aggressive colorectal cancer metastases in the era of effective chemotherapy: a review

“…According to our pathologic observations in patients who underwent chemotherapy and hepatectomy and had metastases attached to major intrahepatic vessels (unpublished data), approximately 60% of hepatic vessels remained attached to or invaded by tumors even after chemotherapy. Frequency of vessel invasion or attachment after chemotherapy differed little from previous results for patients without chemotherapy [102,103]. Thus, we noted difficulty in achieving separation of liver metastases and major vessels by prehepatectomy chemotherapy (Fig.…”

Postchemotherapy histological analysis of major intrahepatic vessels for reversal of attachment or invasion by colorectal liver metastases

“…More generally, in reports of patients suspected to have invasion of the hepatic IVC, cancer invasion of the IVC wall was confirmed histologically in approximately 45%-60% of patients who underwent concomitant liver and IVC resection. 7,8 The frequency of vessel invasion or attachment after chemotherapy in our study differed little from these previous results for patients without chemotherapy. Thus, difficulty of achieving separation of liver metastases and major vessels by prehepatectomy chemotherapy was demonstrated.…”

Modified hanging manoeuvre facilitates inferior vena cava resection and reconstruction during extended right hepatectomy: A technical case report

“…The radiological criteria predictive of malignant invasion include: Longitudinal IVC indentation for >50 mm, transverse compression of >50% of the IVC circumference, lesions protruding into the IVC lumen, and the presence of well-developed collaterals (4). Maeba et al (4) reported that the presence of ≥1 of these radiological criteria may predict malignant IVC invasion with 60% overall accuracy. Using these criteria, IVC invasion was anticipated in our patient, since there was compression of >50% of the transverse IVC diameter and >5 cm longitudinal IVC compression.…”

“…Despite malignant IVC invasion, an aggressive attempt was made at R0 margin clearance, as IVC resection and reconstruction is currently considered to be potentially curative when it results in histologically clear margins (3,4,(6)(7)(8). In these cases, the conventional techniques for liver resection may not be feasible.…”

“…However, in certain, more complex cases, applying techniques such as the liver hanging manoeuvre may be required (2). In addition, when there is compression or malignant invasion of the inferior vena cava (IVC) by hepatic tumours, as indicated by preoperative radiological imaging (3,4), the associated perioperative morbidity and mortality increase. In order to mitigate these risks and safely perform complex resections, modifications of the conventional liver resection techniques become necessary.…”