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Asaoka T, Furukawa K, Mikamori M, Hyuga S, Ohashi T, Kazuya I, Nakahara Y, Naito A, Takahashi H, Moon J, Imasato M, Matsuda C, Nishikawa K, Mizushima T. Portal vein wedge resection and patch venoplasty with autologous vein grafts for hepatobiliary-pancreatic cancer. Surg Case Rep 2024; 10:27. [PMID: 38273043 PMCID: PMC10811310 DOI: 10.1186/s40792-024-01823-y] [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: 11/04/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Advanced hepatobiliary-pancreatic cancer often invades critical blood vessels, including the portal vein (PV) and hepatic artery. Resection with tumor-free resection margins is crucial to achieving a favorable prognosis in these patients. Herein, we present our cases and surgical techniques for PV wedge resection with patch venoplasty using autologous vein grafts during surgery for pancreatic ductal adenocarcinoma (PDAC) and perihilar cholangiocarcinoma (PhCC). CASE PRESENTATION Case 1: 73-year-old female patient with PDAC; underwent subtotal stomach-preserving pancreatoduodenectomy, with superior mesenteric vein wedge resection and venoplasty with the right gonadal vein. Case 2: 67-year-old male patient with PDAC; underwent distal pancreatectomy and celiac axis resection, with PV wedge resection and venoplasty with the middle colic vein. Case 3: 51-year-old female patient with type IV PhCC; underwent left hepatectomy with caudate lobectomy and bile duct resection, with hilar PV wedge resection and venoplasty with the inferior mesenteric vein (IMV). Case 4: 69-year-old male patient with type IIIA PhCC; underwent right hepatopancreatoduodenectomy, with hilar PV resection and patch venoplasty with the IMV. All patients survived for over 12 months after the surgery, without local recurrence. CONCLUSIONS PV wedge resection and patch venoplasty is a useful technique for obtaining tumor-free margins in surgeries for hepatobiliary-pancreatic cancer.
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Affiliation(s)
- Tadafumi Asaoka
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayamacho, Tennouji-Ku, Osaka, 543-0035, Japan.
| | - Kenta Furukawa
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayamacho, Tennouji-Ku, Osaka, 543-0035, Japan
| | - Manabu Mikamori
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayamacho, Tennouji-Ku, Osaka, 543-0035, Japan
| | - Satoshi Hyuga
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayamacho, Tennouji-Ku, Osaka, 543-0035, Japan
| | - Tomofumi Ohashi
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayamacho, Tennouji-Ku, Osaka, 543-0035, Japan
| | - Iwamoto Kazuya
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayamacho, Tennouji-Ku, Osaka, 543-0035, Japan
| | - Yujiro Nakahara
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayamacho, Tennouji-Ku, Osaka, 543-0035, Japan
| | - Atsushi Naito
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayamacho, Tennouji-Ku, Osaka, 543-0035, Japan
| | - Hidekazu Takahashi
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayamacho, Tennouji-Ku, Osaka, 543-0035, Japan
| | - Jeongho Moon
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayamacho, Tennouji-Ku, Osaka, 543-0035, Japan
| | - Mitsunobu Imasato
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayamacho, Tennouji-Ku, Osaka, 543-0035, Japan
| | - Chu Matsuda
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayamacho, Tennouji-Ku, Osaka, 543-0035, Japan
| | - Kazuhiro Nishikawa
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayamacho, Tennouji-Ku, Osaka, 543-0035, Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayamacho, Tennouji-Ku, Osaka, 543-0035, Japan
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Vargas PA, Dar N, de Souza Martins Fernandes E, Goldaracena N. Surgical approach to achieve R0 resections in primary and metastatic liver tumors: a literature review. J Gastrointest Oncol 2023; 14:1949-1963. [PMID: 37720424 PMCID: PMC10502561 DOI: 10.21037/jgo-22-778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/15/2022] [Indexed: 09/19/2023] Open
Abstract
Background and Objective Primary and metastatic liver tumors are a significant cause of mortality worldwide. Regardless of the etiology of the tumor, macro- and microscopically clear margins (R0) while preserving adequate function of the remaining organ are the main goals after liver resections. However, technically challenging procedures are required to achieve R0 resection. Currently, there is no consensus of which should be the ideal minimal safety margin for liver tumor resections, with contrasting reports in regards of safety, tumor recurrence and overall outcomes following R0. Therefore, we aim to review current worldwide surgical practices to achieve R0 resections for primary and metastatic liver tumors in challenging surgical techniques and their reported outcomes. Methods PubMed database, Google Scholar, and OVID Medline were searched for peer-reviewed original articles related to surgical techniques performed to achieve R0 resections in the setting of primary and/or metastatic liver tumors. An up-to-date review of English-language articles published between 2015 to July 2022 was performed. Key Content and Findings Primary and metastatic liver tumors can be effectively treated using hepatic resection. Current literature highlights that tumors involving major vascular structures are not uncommon. Surgical advances have allowed for vascular control techniques, as well as vascular resections to be performed in a feasible and safe manner to achieve R0 resections. Complex resections combining surgical techniques can be performed in certain population after a detailed evaluation. Liver transplantation (LT) have been used with varying degrees of success for treatment of patients with hepatocellular carcinoma, cholangiocarcinoma (CCA), colorectal liver metastases (CRLM), non-resectable CRLM and metastatic neuroendocrine tumors. Conclusions Safety and feasibility of R0 resections have been reported for multiple techniques. Technical complexity should not be a limitation to achieve or pursue R0 tumor resection. However, there has to be a balance between patient risk/benefit in attempting R0 resections. Adequate training of surgeons on implementation of complex techniques, as well as transplant oncology techniques applied to hepato-pancreato-biliary (HPB) surgery represents as a promising path to improve short and long-term outcomes for liver-related oncology patients.
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Affiliation(s)
- Paola A. Vargas
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Nakul Dar
- School of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Nicolas Goldaracena
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
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Voit A, Commander SJ, Williams Z. Partial Inferior Vena Cava Reconstruction with Cryopreserved Aortic Homograft Following Resection for Malignancy. Vasc Endovascular Surg 2022; 57:79-82. [DOI: 10.1177/15385744221124297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Malignant invasion of the inferior vena cava (IVC) often necessitates complete tumor thrombectomy and IVC reconstruction. Bovine pericardial xenografts and prosthetic grafts are frequently used for partial or entire IVC reconstruction with adequate subsequent patency and freedom from thrombosis. Cryopreserved aortic homografts represent an alternative conduit for vena cava replacement with resistance to infection in contaminated fields or following extensive retroperitoneal dissection. Specific reports of aortic homograft use for IVC reconstruction are scarce. Described are 2 cases of cryopreserved aortoiliac artery allograft use for long segment cava patch repair while avoiding extensive caval reconstruction, mobilization and the need for renal vein and hepatic vein re-implantation.
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Affiliation(s)
- Antanina Voit
- Division of Vascular and Endovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | - Sarah Jane Commander
- Division of Vascular and Endovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | - Zachary Williams
- Division of Vascular and Endovascular Surgery, Duke University Medical Center, Durham, NC, USA
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