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Silva JCFD, Diniz AL, Torres SM, Silva DA, Ribeiro HSDC, de Godoy AL, de Farias IC, Felismino TC, da Costa Junior WL, Coimbra FJF. Influence of biliary and vascular resection types on morbidity in hepatectomies with vascular involvement. J Surg Oncol 2024. [PMID: 39104086 DOI: 10.1002/jso.27718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/13/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION Hepatectomies associated with vascular resections pose a technical challenge for surgeons, involving multiple reconstruction techniques. Moreover, adding clinical and surgical risks in the postoperative setting of these complex procedures are mainly due to prolonged surgical periods and potential complications inherent to vascular manipulation. Leveraging the expertise of a Cancer Center, we propose an institutional assessment utilizing the case series from A. C. Camargo Cancer Center in hepatectomies associated with vascular resection, evaluating postoperative complications and outcomes while highlighting clinical, laboratory, pathological, and surgical factors that may influence results. OBJECTIVE To assess mortality and morbidity associated with hepatectomies involving vascular resection. MATERIALS AND METHODS From a prospective database, a study was performed evaluating postoperative survival and morbidity using scoring systems such as Clavien-Dindo through a cohort analysis. RESULTS From a total of 1021 liver resections for a period of 10 years, 31 cases were evaluated from a unique cancer center in Brazil! Factors such as the performance of major hepatectomies, the need for blood transfusion, and the administration of neoadjuvant or adjuvant systemic therapy did not appear to influence the outcome of morbidity or mortality. However, the resection of the associated bile duct and the type of vascular resection seemed to influence morbidity outcomes with statistical significance (p = 0.006+ …). CONCLUSION Hepatectomies associated with vascular resections are safe in selected cases and when performed in referral centers. Factors such as associated bile duct resection and type of vascular resection should be considered for procedure indication.
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Affiliation(s)
| | - Alessandro L Diniz
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Silvio M Torres
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Dante A Silva
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Héber S D C Ribeiro
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - André Luiz de Godoy
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
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Chang WJ, Chen CB, Chang YT, Wen TC, Wu SC, Lin KH, Huang SY. ASO Author Reflections: Advancements in Laparoscopic Parenchyma-Sparing Liver Resection: Autologous Peritoneal Patch for Middle Hepatic Vein Reconstruction in Colorectal Liver Metastasis. Ann Surg Oncol 2024; 31:2598-2599. [PMID: 38326637 DOI: 10.1245/s10434-023-14684-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 02/09/2024]
Affiliation(s)
- Wei-Jung Chang
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chia-Bang Chen
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
| | - Yun-Tzu Chang
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Tzu-Cheng Wen
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Szu-Chia Wu
- Transplant Medicine and Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Kuo-Hua Lin
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Shuan-Yuan Huang
- Division of Colorectal Surgery, Changhua Christian Hospital, Changhua, Taiwan.
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Baumgart J, Hiller S, Stroh K, Kloth M, Lang H. Resection of Colorectal Liver Metastases with Major Vessel Involvement. Cancers (Basel) 2024; 16:571. [PMID: 38339321 PMCID: PMC10854547 DOI: 10.3390/cancers16030571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Treatment of CRLM with major vessel involvement is still challenging and valid data on outcomes are still rare. We analyzed our experience of hepatectomies with resection and reconstruction of major hepatic vessels with regard to operative and perioperative details, histopathological findings and oncological outcome. METHODS Data of 32 hepatectomies with major hepatic vessel resections and reconstructions were included. Results were correlated with perioperative and oncological outcome. RESULTS Out of 1236 surgical resections due to CRLM, we performed 35 major hepatic vessel resections and reconstructions in 32 cases (2.6%) during the study period from January 2008 to March 2023. The vena cava inferior (VCI) was resected and reconstructed in 19, the portal vein (PV) in 6 and a hepatic vein (HV) in 10 cases. Histopathological examination confirmed a vascular infiltration in 6/32 patients (VCI 3/17, HV 2/10 and PV 1/6). There were 27 R0 and 5 R1 resections. All R1 situations affected the parenchymal margin. Vascular wall margins were R0. Ninety-day mortality was 0. The median overall survival (OS) for the patient group with vascular infiltration (V1) was 21 months and for the V0 group 33.3 months. CONCLUSION Liver resections with vascular resection and reconstruction are rare and histological vessel infiltration occurs seldom. In cases with presumed vascular wall infiltration, liver resection combined with major vessel resection and reconstruction can be performed with low morbidity and mortality. We prefer a parenchymal sparing liver resection with vascular resection and reconstruction to achieve negative resection margins, but in technically difficult cases with higher risk for postoperative complications, tumor detachment from vessels without resection is a most reasonable surgical alternative.
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Affiliation(s)
- Janine Baumgart
- Department of General, Visceral and Transplantation Surgery, Universitätsmedizin Mainz, 55131 Mainz, Germany; (J.B.); (S.H.)
| | - Sebastian Hiller
- Department of General, Visceral and Transplantation Surgery, Universitätsmedizin Mainz, 55131 Mainz, Germany; (J.B.); (S.H.)
| | - Kristina Stroh
- Department of Diagnostic and Interventional Radiology, Universitätsmedizin Mainz, 55131 Mainz, Germany;
| | - Michael Kloth
- Department of Pathology, Universitätsmedizin Mainz, 55131 Mainz, Germany;
| | - Hauke Lang
- Department of General, Visceral and Transplantation Surgery, Universitätsmedizin Mainz, 55131 Mainz, Germany; (J.B.); (S.H.)
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Voskanyan SE, Artemiev AI, Naidenov EV, Kolyshev IY, Shabalin MV, Bashkov AN, Chursin DV, Subkhonov HA, Raspopov DS. [Vascular reconstruction and transplantation technologies in liver surgery (part II)]. Khirurgiia (Mosk) 2024:24-31. [PMID: 38344957 DOI: 10.17116/hirurgia202402124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To systematize tactical and technical aspects of liver resections with reconstruction of afferent and efferent blood supply and/or inferior vena cava; to study postoperative outcomes in patients with focal liver lesions using transplantation technologies. MATERIAL AND METHODS We enrolled 413 patients with parasitic lesions, primary and secondary liver tumors involving great vessels (portal vein, hepatic artery, hepatic veins, inferior vena cava, right atrium). All ones underwent liver resections with vascular resection and reconstruction, as well as liver autotransplantation in vivo, ante situ (ex situ in vivo), extracorporeal liver resections with autotransplantation (ex vivo). RESULTS We obtained satisfactory immediate results after liver resections using transplantation technologies. CONCLUSION Transplantation technologies in liver surgery can significantly increase resectability of tumors and survival of patients. Transplantation technologies are an important new surgical strategy and necessary option in modern hepatic surgery.
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Affiliation(s)
- S E Voskanyan
- Burnasyan Federal Medical Biophysical Center, Moscow, Russia
| | - A I Artemiev
- Burnasyan Federal Medical Biophysical Center, Moscow, Russia
| | - E V Naidenov
- Burnasyan Federal Medical Biophysical Center, Moscow, Russia
| | - I Yu Kolyshev
- Burnasyan Federal Medical Biophysical Center, Moscow, Russia
| | - M V Shabalin
- Burnasyan Federal Medical Biophysical Center, Moscow, Russia
| | - A N Bashkov
- Burnasyan Federal Medical Biophysical Center, Moscow, Russia
| | - D V Chursin
- Burnasyan Federal Medical Biophysical Center, Moscow, Russia
| | - H A Subkhonov
- Burnasyan Federal Medical Biophysical Center, Moscow, Russia
| | - D S Raspopov
- Burnasyan Federal Medical Biophysical Center, Moscow, Russia
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Serradilla-Martín M, Oliver-Guillén JR, Ruíz-Quijano P, Palomares-Cano A, de la Plaza-Llamas R, Ramia JM. Surgery of Colorectal Liver Metastases Involving the Inferior Vena Cava: A Systematic Review. Cancers (Basel) 2023; 15:cancers15112965. [PMID: 37296926 DOI: 10.3390/cancers15112965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Combined hepatic and inferior vena cava (IVC) resection is the only potentially curative treatment for patients with colorectal liver metastases (CRLM) involving the IVC. Most of the existing data come from case reports or small case series. In this paper, a systematic review based on the PICO strategy was performed in accordance with the PRISMA statement. Papers from January 1980 to December 2022 were searched in Embase, PubMed, and the Cochrane Library databases. Articles considered for inclusion had to present data on simultaneous liver and IVC resection for CRLM and report surgical and/or oncological outcomes. From a total of 1175 articles retrieved, 29, including a total of 188 patients, met the inclusion criteria. The mean age was 58.3 ± 10.8 years. The most frequent techniques used were right hepatectomy ± caudate lobe for hepatic resections (37.8%), lateral clamping (44.8%) for vascular control, and primary closure (56.8%) for IVC repair. The thirty-day mortality reached 4.6%. Tumour relapse was reported in 65.8% of the cases. The median overall survival (OS) was 34 months (with a confidence interval of 30-40 months), and the 1-year, 3-year, and 5-year OS were 71.4%, 19.8%, and 7.1%, respectively. In the absence of prospective randomized studies, which are difficult to perform, IVC resection seems to be safe and feasible.
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Affiliation(s)
- Mario Serradilla-Martín
- Department of Surgery, Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain
| | | | | | - Ana Palomares-Cano
- Department of Surgery, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain
| | | | - José Manuel Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, 03010 Alicante, Spain
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Voskanyan SE, Artemiev AI, Naidenov EV, Kolyshev IY, Shabalin MV, Bashkov AN, Chursin DV, Subkhonov KA, Raspopov DS. [Vascular reconstructions and transplant technologies in liver surgery (part I)]. Khirurgiia (Mosk) 2023:46-55. [PMID: 36583493 DOI: 10.17116/hirurgia202301146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To systematize technical aspects of liver resections with reconstruction of afferent and efferent liver blood supply and/or inferior vena cava, as well as to analyze the results of surgical treatment in patients with focal liver lesions. MATERIAL AND METHODS The study included 413 patients with parasitic lesions, primary and secondary liver tumors with great vessel invasion (portal vein, hepatic artery, hepatic veins, inferior vena cava, right atrium). These features excluded radical liver resections without vascular resection and reconstruction, as well as liver autotransplantation in vivo, liver autotransplantation ante situ (ex situ in vivo), extracorporeal liver resections with autotransplantation (ex vivo). RESULTS Surgical interventions were systematized depending of surgical tactics and techniques, technical complexity, type and number of reconstructed vessels, the use of total vascular isolation and cold preservation techniques, resection and reconstruction of great vessels. Thus, 4 gradations were allocated (Grade I-IV). The definition of transplantation technologies in liver surgery was proposed. CONCLUSION Transplantation technologies in liver surgery include liver resections supplemented with vascular reconstruction of afferent and efferent liver blood supply, inferior vena cava including total vascular isolation of liver under normo- or hypothermia. These measures can significantly extend the possibilities of resection.
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Affiliation(s)
- S E Voskanyan
- Burnazyan Federal Medical Biophysical Center, Moscow, Russia
| | - A I Artemiev
- Burnazyan Federal Medical Biophysical Center, Moscow, Russia
| | - E V Naidenov
- Burnazyan Federal Medical Biophysical Center, Moscow, Russia
| | - I Yu Kolyshev
- Burnazyan Federal Medical Biophysical Center, Moscow, Russia
| | - M V Shabalin
- Burnazyan Federal Medical Biophysical Center, Moscow, Russia
| | - A N Bashkov
- Burnazyan Federal Medical Biophysical Center, Moscow, Russia
| | - D V Chursin
- Burnazyan Federal Medical Biophysical Center, Moscow, Russia
| | - Kh A Subkhonov
- Burnazyan Federal Medical Biophysical Center, Moscow, Russia
| | - D S Raspopov
- Burnazyan Federal Medical Biophysical Center, Moscow, Russia
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Sebai A, Tzedakis S, Livin M, Sulpice L, Jeddou H, Boudjema K. Prosthetic Reconstruction of the Cavo-Hepatic Venous Confluence for a Colorectal Cancer Liver Recurrence. Ann Surg Oncol 2022; 29:3881-3883. [PMID: 35239098 DOI: 10.1245/s10434-022-11378-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/16/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Amine Sebai
- Department of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, Rennes, France
| | - Stylianos Tzedakis
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Cochin University Hospital, AP-HP, University of Paris, Paris, France
| | - Marie Livin
- Department of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, Rennes, France
| | - Laurent Sulpice
- Department of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, Rennes, France
| | - Heithem Jeddou
- Department of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, Rennes, France
| | - Karim Boudjema
- Department of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, Rennes, France.
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Apers T, Hendrikx B, Bracke B, Hartman V, Roeyen G, Ysebaert D, Op de Beeck B, Chapelle T. Parenchymal-sparing hepatectomy with hepatic vein resection and reconstruction. Acta Chir Belg 2021; 122:334-340. [PMID: 33860723 DOI: 10.1080/00015458.2021.1915021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hepatectomy remains the most important treatment modality for most malignant liver tumors. Vascular involvement stays a reason for unresectability or major parenchymal resection. A possible way to avoid this is parenchymal-sparing hepatectomy (PSHX) with vascular resection and reconstruction (HVRR). In this article, we aim to demonstrate the specific role of this technique in avoiding post-hepatectomy liver failure (PHLF). METHODS A retrospective analysis of 10 patients who underwent HVRR was conducted. 99mTechnetium-mebrofenin hepatobiliary scintigraphy (HBS) was used to predict the future liver remnant function (FLRF). Calculations were made for each patient to compare HVRR and major hepatectomy (with or without portal vein embolization). RESULTS In our cohort, there was no perioperative mortality. Two patients suffered a Clavien-Dindo grade 3a complication and none had clinically significant PHLF. Estimated FLRF was significantly higher in HVRR compared to major hepatectomy after portal vein embolization (p < .005). CONCLUSIONS Instead of focusing on inducing liver remnant hypertrophy, preserving parenchyma through HVRR can be an interesting treatment strategy. It can be performed with an acceptable operative risk. Calculations of FLRF (using HBS) suggest that this approach is able to reduce the risk for PHLF and related morbidity or mortality.
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Affiliation(s)
- Thomas Apers
- Department of Hepatobiliary and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Bart Hendrikx
- Department of Hepatobiliary and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Bart Bracke
- Department of Hepatobiliary and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vera Hartman
- Department of Hepatobiliary and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Geert Roeyen
- Department of Hepatobiliary and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Dirk Ysebaert
- Department of Hepatobiliary and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Bart Op de Beeck
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Thiery Chapelle
- Department of Hepatobiliary and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
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Matsuki R, Momose H, Kogure M, Suzuki Y, Sakamoto Y. Bisegmentectomy and venous reconstruction after portal vein embolization for the remnant hemiliver in a patient with recurrent colorectal liver metastases. Ann Gastroenterol Surg 2021; 5:259-264. [PMID: 33860147 PMCID: PMC8034697 DOI: 10.1002/ags3.12393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/01/2020] [Accepted: 08/06/2020] [Indexed: 12/02/2022] Open
Abstract
Repeat hepatectomy for recurrent colorectal liver metastases (CRLM) for the remnant hemiliver is sometimes challenging due to the insufficient future liver remnant (FLR) volume. We present an aggressive strategy for resection of the recurrent CRLM involving bisegmentectomy of the remnant right hemiliver with the aid of portal vein embolization (PVE) and venous reconstruction. The patient was a 50-year-old woman who had undergone left hemihepatectomy for a CRLM 10 months ago. Three metastatic tumors were found in the remnant segments 7 and 8 (S7&8) of the liver, and one of them involved the right hepatic vein (RHV). Conducting bisegmentectomy of S7&8 with resection of the RHV, the non-congestive FLR volume was calculated as 34.9% of the remnant total liver volume, which was deemed insufficient considering the mild liver damage after repeated chemotherapy. After trans-ileocecal PVE of the portal branches in S7&8 in a hybrid angio room, the non-congestive FLR volume increased to 42.3%, which could be further advanced to 58.0% if the RHV was reconstructed. Segmentectomies of S7&8 with resection and reconstruction of the RHV using the right superficial femoral vein graft was performed. The patient was discharged without any complications, and the postoperative computed tomography (CT) scan showed the good patency of the reconstructed venous graft. Aggressive segmentectomies and venous reconstruction of the remnant hemiliver after PVE might be a new strategy to overcome the insufficient FLR volume.
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Affiliation(s)
- Ryota Matsuki
- Department of Hepato‐Biliary‐Pancreatic SurgeryKyorin University HospitalMitakaJapan
| | - Hirokazu Momose
- Department of Hepato‐Biliary‐Pancreatic SurgeryKyorin University HospitalMitakaJapan
| | - Masaharu Kogure
- Department of Hepato‐Biliary‐Pancreatic SurgeryKyorin University HospitalMitakaJapan
| | - Yutaka Suzuki
- Department of Hepato‐Biliary‐Pancreatic SurgeryKyorin University HospitalMitakaJapan
| | - Yoshihiro Sakamoto
- Department of Hepato‐Biliary‐Pancreatic SurgeryKyorin University HospitalMitakaJapan
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Langella S, Menonna F, Casella M, Russolillo N, Lo Tesoriere R, Alessandro F. Vascular Resection During Hepatectomy for Liver Malignancies. Results from a Tertiary Center using Autologous Peritoneal Patch for Venous Reconstruction. World J Surg 2021; 44:3100-3107. [PMID: 32418027 DOI: 10.1007/s00268-020-05564-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND To evaluate early outcomes of venous reconstruction with peritoneal patch (PP) during resection for hepatic malignancies. METHODS Since May 2015, PP was considered as the first option for venous reconstruction in the case of lateral resection. Between May 2015 and June 2019, 579 consecutive hepatectomies for malignancies were performed at our institution. Among 27 patients requiring venous resection, PP was used in 22, who were included in the present study. Data from a prospectively collected database were analysed. RESULTS Tumour types were ten colorectal metastases (CRLM), six intrahepatic cholangiocarcinomas, four hilar cholangiocarcinomas, one hepatocellular carcinoma and one gallbladder carcinoma. Hepatectomies were major in 50% of cases. Eleven patients had hepatic vein resections, eight portal vein and three inferior vena cava. Venous reconstruction enabled resection in 12 (54.5%) patients, otherwise non-resectable. Among CRLM, the venous reconstruction allowed avoidance of major resection in eight (80%) cases. Median operative time was 456 min (range 270-960). Blood loss was a median 300 cc (range 40-1500), and blood transfusions were required in three patients (13.6%). At pathological examination, venous infiltration was confirmed in 14 (63.6%) patients. No vascular complications related to the patch were recorded. Post-operative major (Dindo III/IV) complications were observed in two (9%) patients. One patient died because of liver failure without vascular thrombosis and one due to biliary fistula complicated by arterial bleeding. Overall, post-operative mortality was 9% (2/22). CONCLUSIONS Venous reconstruction with peritoneal patch during hepatectomy for malignancies can feasibly allow resection in otherwise unresectable patients and decrease the rate of major resection in colorectal liver metastases.
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Affiliation(s)
- Serena Langella
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy.
| | - Francesca Menonna
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy
| | - Michele Casella
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy
| | - Nadia Russolillo
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy
| | - Roberto Lo Tesoriere
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy
| | - Ferrero Alessandro
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy
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Baimas-George M, Tschuor C, Watson M, Sulzer J, Salibi P, Iannitti D, Martinie JB, Baker E, Clavien PA, Vrochides D. Current trends in vena cava reconstructive techniques with major liver resection: a systematic review. Langenbecks Arch Surg 2020; 406:25-38. [PMID: 32979105 DOI: 10.1007/s00423-020-01989-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/07/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE Historically, invasion of the inferior vena cava (IVC) represented advanced and often unresectable hepatic disease. With surgical and anesthetic innovations, IVC resection and reconstruction have become feasible in selected patients. This review assesses technical variations in reconstructive techniques and post-operative management. METHODS A comprehensive literature search was performed according to PRISMA. Inclusion criteria were (i) peer-reviewed articles in English; (ii) at least three cases; (iii) hepatic IVC resection and reconstruction (January 2015-March 2020). Primary outcomes were reconstructive technique, anti-thrombotic regimen, post-operative IVC patency, and infection. Secondary outcomes included post-operative complications and malignant disease survival. RESULTS Fourteen articles were included allowing for investigation of 351 individual patients. Analysis demonstrated significant heterogeneity in surgical reconstructive technique, anti-thrombotic management, and post-operative monitoring of patency. There was increased utilization of ex vivo approaches and decreased use of venovenous bypass compared with previously published reviews. CONCLUSION This review of literature published between 2015 and 2020 reveals persistent heterogeneity of hepatic IVC reconstructive techniques and peri-operative management. Increased utilization of ex vivo approaches and decreased use of venovenous bypass point towards improved operative techniques, peri-operative management, and anesthesia. In order to gain evidence for consensus on management, a registry would be beneficial.
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Affiliation(s)
- Maria Baimas-George
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA
| | - Christoph Tschuor
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA.,Department of Surgery & Transplantation, University Hospital of Zurich, Zurich, Switzerland
| | - Michael Watson
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA
| | - Jesse Sulzer
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA
| | - Patrick Salibi
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA
| | - David Iannitti
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA
| | - John B Martinie
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA
| | - Erin Baker
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA
| | - Pierre-Alain Clavien
- Department of Surgery & Transplantation, University Hospital of Zurich, Zurich, Switzerland
| | - Dionisios Vrochides
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA.
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How Has Virtual Hepatectomy Changed the Practice of Liver Surgery?: Experience of 1194 Virtual Hepatectomy Before Liver Resection and Living Donor Liver Transplantation. Ann Surg 2019; 268:127-133. [PMID: 28288065 DOI: 10.1097/sla.0000000000002213] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess how virtual hepatectomy (VH), conducted using surgical planning software, influences the outcomes of liver surgery. BACKGROUND Imaging technology visualizes the territories of the liver vessels, which were previously impossible. However, the clinical impact of VH has not been evaluated. METHODS From 2004 to 2013, we performed 1194 VHs preoperatively. Outcomes of living donor liver transplantation (LDLT) and hepatectomy for hepatocellular carcinoma (HCC)/colorectal liver metastases (CRLM) were compared between patients in whom VH was performed (VH) and those without VH evaluation (non-VH). RESULTS In LDLT, the rate of right liver graft use was higher in the VH (62.1%) than in the non-VH (46.5%) (P < 0.01), which did not increase morbidity of donor surgery. Duration of recipient surgery in the VH in which middle hepatic vein branch reconstruction was skipped was shorter than that in the VH with venous reconstruction. Among HCC patients with impaired liver function, portal territory-oriented resection was conducted more often in the VH than in the non-VH. The 5-year disease-free survival rate for localized HCC was higher in the VH than in the non-VH (37.2% vs 23.9%; P = 0.04). In CRLM, long-term outcomes were similar in the VH and non-VH despite the larger tumor load in the VH. CONCLUSIONS VH in LDLT allows double equipoise for the recipient and donor by optimizing decision-making on graft selection and venous reconstruction. VH offers a chance for radical hepatectomy even in HCC patients with impaired liver function and CRLM patients with advanced tumors, without compromising survival.
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Imai K, Adam R, Baba H. How to increase the resectability of initially unresectable colorectal liver metastases: A surgical perspective. Ann Gastroenterol Surg 2019; 3:476-486. [PMID: 31549007 PMCID: PMC6749948 DOI: 10.1002/ags3.12276] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/29/2019] [Accepted: 06/20/2019] [Indexed: 12/15/2022] Open
Abstract
Although surgical resection is the only treatment of choice that can offer prolonged survival and a chance of cure in patients with colorectal liver metastases (CRLM), nearly 80% of patients are deemed to be unresectable at the time of diagnosis. Considerable efforts have been made to overcome this initial unresectability, including expanding the indication of surgery, the advent of conversion chemotherapy, and development and modification of specific surgical techniques, regulated under multidisciplinary approaches. In terms of specific surgical techniques, portal vein ligation/embolization can increase the volume of future liver remnant and thereby reduce the risk of hepatic insufficiency and death after major hepatectomy. For multiple bilobar CRLM that were traditionally considered unresectable even with preoperative chemotherapy and portal vein embolization, two-stage hepatectomy was introduced and has been adopted worldwide with acceptable short- and long-term outcomes. Recently, ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) was reported as a novel variant of two-stage hepatectomy. Although issues regarding safety remain unresolved, rapid future liver remnant hypertrophy and subsequent shorter intervals between the two stages lead to a higher feasibility rate, reaching 98%. In addition, adding radiofrequency ablation and vascular resection and reconstruction techniques can allow expansion of the pool of patients with CRLM who are candidates for liver resection and thus a cure. In this review, we discuss specific techniques that may expand the criteria for resectability in patients with initially unresectable CRLM.
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Affiliation(s)
- Katsunori Imai
- Department of Gastroenterological SurgeryGraduate School of Life SciencesKumamoto UniversityKumamotoJapan
| | - René Adam
- Centre Hépato‐BiliaireAP‐HPHôpital Universitaire Paul BrousseVillejuifFrance
| | - Hideo Baba
- Department of Gastroenterological SurgeryGraduate School of Life SciencesKumamoto UniversityKumamotoJapan
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Leon P, Al Hashmi AW, Navarro F, Panaro F. Peritoneal patch for retrohepatic vena cava reconstruction during major hepatectomy: how I do it. Hepatobiliary Surg Nutr 2019; 8:138-141. [PMID: 31098361 DOI: 10.21037/hbsn.2019.01.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Piera Leon
- Department of General and Liver Transplant Surgery, University Hospital in Montpellier, Saint Eloi Hospital, Montpellier-Cedex, France
| | - Al Warith Al Hashmi
- Department of General and Liver Transplant Surgery, University Hospital in Montpellier, Saint Eloi Hospital, Montpellier-Cedex, France
| | - Francis Navarro
- Department of General and Liver Transplant Surgery, University Hospital in Montpellier, Saint Eloi Hospital, Montpellier-Cedex, France
| | - Fabrizio Panaro
- Department of General and Liver Transplant Surgery, University Hospital in Montpellier, Saint Eloi Hospital, Montpellier-Cedex, France
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Two-stage hepatectomy aiming for the development of intrahepatic venous collaterals for multiple colorectal liver metastases. Surg Case Rep 2018; 4:17. [PMID: 29453737 PMCID: PMC5815977 DOI: 10.1186/s40792-018-0424-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 02/05/2018] [Indexed: 01/11/2023] Open
Abstract
Background Aggressive hepatectomy with venous resection has a higher risk of postoperative liver failure (POLF) than hepatectomy without venous reconstruction; however, venous reconstruction is technically demanding. We performed a novel two-stage hepatectomy (TSH) without venous reconstruction in a patient with bilobar multiple colorectal liver metastases located near the caval confluence, waiting for the development of intrahepatic venous collaterals between procedures. Case presentation A 60-year-old man was referred to our hospital with sigmoid colon cancer accompanied by intraabdominal abscess and two synchronous liver metastases. One of the liver tumors (tumor 1) was located in segment 8 near the caval confluence and was attached to both the right hepatic vein (RHV) and middle hepatic vein (MHV). The other tumor (tumor 2) in the left lobe invaded the umbilical portion of the portal vein. Both liver metastases decreased in size after four cycles of panitumumab/5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) therapy. Radical liver resection was planned because tumor 1 had not invaded the MHV. However, three-dimensional volumetric software showed that the non-congested volume of the future liver remnant was estimated at 354 ml, which corresponded to 26.3% of the total liver volume. TSH was scheduled to avoid POLF. We first performed limited resection of segment 8 with resection of the RHV root. After the first hepatectomy, the development of intrahepatic venous collaterals between the RHV and MHV was seen on computed tomography and magnetic resonance imaging. The estimated non-congested future liver remnant was 1242 ml, 78.5% of the total liver volume. Therefore, the patient underwent left hemihepatectomy 58 days after the first hepatectomy. We saw no adhesions around the porta hepatis, and the left hepatic artery and left branch of the portal vein were safely exposed and divided. Intraoperative Doppler ultrasonography revealed intrahepatic venous collaterals arising from RHV to MHV. The patient’s postoperative course was uneventful, and he underwent eight cycles of panitumumab/FOLFOX therapy for 5 months after the second hepatectomy. Conclusions Our TSH strategy helped avoid POLF by waiting for the development of intrahepatic venous collaterals.
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Ludwig DR, Mintz AJ, Sanders VR, Fowler KJ. Liver Imaging for Colorectal Cancer Metastases. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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