Total vascular exclusion for liver resections: Pros and cons

Abstract

Dramatic improvements in morbidity and mortality rates following liver resections have been reported in the past decade. Consequently, the indications for hepatectomy are becoming more liberal. Many techniques of liver resection with or without vascular clamping have been reported with excellent clinical results. Total vascular exclusion (TVE) of the liver during parenchymal transection has been advocated susceptible to increase the resectability of tumors that might not be safely approached by other techniques. Cirrhotic livers are probably more vulnerable to ischemic injury related to TVE than normal livers. The indications and technical and metabolic aspects of the technique are reviewed. J. Surg. Oncol. 1999;72:50–56. © 1999 Wiley‐Liss, Inc.

Complex Hepatectomy under Total Vascular Exclusion of the Liver: Impact of Ischemic Preconditioning on Clinical Outcomes

“…Habib et al [29] reported a 39 % postoperative morbidity rate in 56 liver resections with complete hepatic vascular exclusion in non-cirrhotic patients. Extensive mobilization of the liver including suprahepatic IVC could predispose to formation of postoperative subphrenic fluid collections and pleural effusions [16]. Thus, despite the high number of patients with complex resections, including a significant cirrhotic population, our overall morbidity and mortality rates are consistent with reported data.…”

“…TVE offers the advantage of combining total vascular inflow and outflow occlusion of the liver, thus isolating it completely from the systematic circulation. This approach can decrease intraoperative blood loss and increase the resectability of centrally or posteriorly located tumors close to the major hepatic veins or the IVC [15][16][17]. The benefits of TVE, however, are tempered by the impact of I/R injury.…”

Patch venoplasty for resecting tumor invading the retrohepatic inferior vena cava using total and selective hepatic vascular exclusion

“…The development of living donor liver transplantation (LDLT) in Korea has contributed to the reciprocal advancement in aggressive hepatobiliary surgeries, especially regarding vascular reconstruction of the IVC and portal vein [ 1 ]. Clamping of the IVC such as total hepatic vascular exclusion (THVE) is not frequently performed during hepatobiliary surgery [ 2 - 7 ]. However, it is an essential procedure for liver transplantation.…”