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Ghoreifi A, Djaladat H. Re: Palacios AR, Schmeusser BN, Midenberg E, et al. Resection of retroperitoneal tumors with inferior vena cava involvement without caval reconstruction. J Surg Oncol. 2022. doi:10.1002/jso.27052. J Surg Oncol 2022; 126:1574-1575. [DOI: 10.1002/jso.27120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Alireza Ghoreifi
- Norris Comprehensive Cancer Center, Institute of Urology University of Southern California Los Angeles California USA
| | - Hooman Djaladat
- Norris Comprehensive Cancer Center, Institute of Urology University of Southern California Los Angeles California USA
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Aimanan K, Koay KL, Hayati F, Tajri HM. Single-stage inferior vena caval intravenous leiomyomatosis excision. BMJ Case Rep 2022; 15:e250261. [PMID: 35953149 PMCID: PMC9379474 DOI: 10.1136/bcr-2022-250261] [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: 11/04/2022] Open
Abstract
Intravascular tumour extension can occur in many different types of cancer. Those with the highest tendency include renal cell carcinoma, adrenal cortical carcinoma and hepatocellular carcinoma. Inferior vena cava (IVC) tumour thrombus in gynaecological malignancy is rarely reported. We present a report on a female patient with extensive IVC tumour thrombus (intravenous leiomyomatosis) with concurrent intrauterine leiomyomatosis. She underwent a single-stage procedure, involving laparotomy and a sternotomy to remove her pelvic tumour, as well as the intracaval and intracardiac thrombus. The clinical presentation and management of this rare tumour will be detailed in this case report.
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Affiliation(s)
- Karthigesu Aimanan
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
- Department of Surgery, Hospital Serdang, Kajang, Selangor, Malaysia
| | - Kean Leong Koay
- Department of Surgery, Hospital Serdang, Kajang, Selangor, Malaysia
| | - Firdaus Hayati
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
- Department of Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
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Palacios AR, Schmeusser BN, Midenberg E, Patil D, Xie L, Nabavizadeh R, Ogan K, Cardona K, Maithel SK, Master VA. Resection of retroperitoneal tumors with inferior vena cava involvement without caval reconstruction. J Surg Oncol 2022; 126:1306-1315. [PMID: 35943295 DOI: 10.1002/jso.27052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/24/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Retroperitoneal tumors with involvement of the inferior vena cava (IVC) often require resection of the IVC to achieve complete tumor removal. This study evaluates the safety and efficacy of IVC ligation without caval reconstruction. METHODS A retrospective chart review of patients who underwent IVC ligation (IVC-Ligation) and IVC resection with reconstruction (IVC-Reconstruction) at our institution between May 2004 and April 2021 was performed. Outcomes from the two surgical techniques were compared via univariate analysis using the Kruskal-Wallis test for continuous variables and Fisher's exact test for categorical variables. RESULTS Forty-nine IVC-Ligation and six IVC-Reconstruction surgeries were identified. There were no differences in baseline demographics, tumor characteristics, complication rates, postoperative morbidity, or overall 5-year survival between groups. IVC-Reconstruction patients were more likely to require intensive care unit admission (83% vs. 33%; p = 0.0257) and the IVC-Ligation cohort had a tendency to present with nondebilitating postoperative lymphedema (35% vs. 0%; p = 0.1615), which resolved for most patients. CONCLUSIONS IVC-Ligation is a viable surgical option for select patients presenting with retroperitoneal tumors with IVC involvement and provides acceptable short- and medium-term outcomes.
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Affiliation(s)
- Arnold R Palacios
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Eric Midenberg
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lillian Xie
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Reza Nabavizadeh
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kenneth Cardona
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shishir K Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
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Brasoveanu V, Barbu I, Balescu I, Bacalbasa N, Cordos I. Infra-hepatic caval resection en bloc with right nephrectomy followed by caval reconstruction for locally advanced caval leiomyosarcoma: A case report and literature review. Exp Ther Med 2021; 22:1377. [PMID: 34650625 DOI: 10.3892/etm.2021.10812] [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: 07/16/2021] [Accepted: 08/16/2021] [Indexed: 11/06/2022] Open
Abstract
Retroperitoneal sarcomas often require complex surgical procedures in order to achieve complete resection; in such cases both vascular and visceral resections are needed. When it comes to the need for vascular reconstruction, the type of graft as well as the type of reconstructive process are chosen according to the length and location of the resected segment. Meanwhile, depending on the location of the resected segment, other vascular reconstructions may be needed such as the reimplantation of the renal veins. However, in certain cases, this reimplantation is not mandatory, an adequate renal outflow being reported through the collateral network at this level. We present the case of a 43-year-old patient diagnosed with a large retroperitoneal sarcoma originating from the cava vein invading the right kidney. Resection of the tumor was performed en bloc with caval resection and right nephrectomy, without reimplantation of the left renal vein at the level of the graft. Extended visceral and vascular resections might be needed in order to achieve complete resection of inferior cava vein sarcomas; re-implantation of the left renal vein being not mandatory if rich collateral circulation is present.
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Affiliation(s)
- Vladislav Brasoveanu
- Department of Visceral Surgery, 'Dan Setlacec' Center of Gastrointestinal Diseases and Liver Transplantation, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Surgery, 'Titu Maiorescu' University of Medicine and Pharmacy, 040051 Bucharest, Romania
| | - Ion Barbu
- Department of Visceral Surgery, 'Dan Setlacec' Center of Gastrointestinal Diseases and Liver Transplantation, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, 'Ponderas' Academic Hospital, 021188 Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Ioan Cordos
- Department of Thoracic Surgery, 'Marius Nasta' National Institute of Pneumology, 050159 Bucharest, Romania.,Department of Thoracic Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Vascular Involvements in Cholangiocarcinoma: Tips and Tricks. Cancers (Basel) 2021; 13:cancers13153735. [PMID: 34359635 PMCID: PMC8345051 DOI: 10.3390/cancers13153735] [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] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary Cholangiocarcinoma (CCA) is the second most common liver primary malignancy and its gold-standard treatment is surgery. Unfortunately, CCA is seldom amenable to curative resection due to late-stage diagnosis and frequent major vascular invasion. Major vascular invasion has historically been considered a contraindication to resection, but lately aggressive surgeries for CCA with vascular involvement have been shown to improve outcomes. The purpose of this review is to provide a comprehensive and up to date summary of the strategies for CCA resection, focusing on the surgical techniques and results of complex procedures with tumour vascular involvements. The current review shows that satisfactory results can be achieved in patients with CCA and tumoral vascular invasion by aggressive surgical resection and challenging vascular reconstruction, ensuring a meticulous evaluation of patients in a multidisciplinary setting by experienced hepatobiliary surgeons. Abstract Cholangiocarcinoma (CCA) is an aggressive malignancy of the biliary tract. To date, surgical treatment remains the only hope for definitive cure of CCA patients. Involvement of major vascular structures was traditionally considered a contraindication for resection. Nowadays, selected cases of CCA with vascular involvement can be successfully approached. Intrahepatic CCA often involves the major hepatic veins or the inferior vena cava and might necessitate complete vascular exclusion, in situ hypothermic perfusion, ex situ surgery and reconstruction with autologous, heterologous or synthetic grafts. Hilar CCA more frequently involves the portal vein and hepatic artery. Resection and reconstruction of the portal vein is now considered a relatively safe and beneficial technique, and it is accepted as a standard option either with direct anastomosis or jump grafts. However, hepatic artery resection remains controversial; despite accumulating positive reports, the procedure remains technically challenging with increased rates of morbidity. When arterial reconstruction is not possible, arterio-portal shunting may offer salvage, while sometimes an efficient collateral system could bypass the need for arterial reconstructions. Keys to achieve success are represented by accurate selection of patients in high-volume referral centres, adequate technical skills and eclectic knowledge of the various possibilities for vascular reconstruction.
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Single-Centre Experience of Supra-Renal Vena Cava Resection and Reconstruction. World J Surg 2021; 45:2270-2279. [PMID: 33728505 DOI: 10.1007/s00268-021-06048-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Tumours involving the supra-renal segment of IVC have dismal prognosis if left untreated. Currently, aggressive surgical management is the only potentially curative treatment but is associated with relatively high morbidity and mortality. This study aims to evaluate perioperative factors, associated with adverse postoperative outcomes, based on the perioperative characteristics and type of IVC reconstruction. METHODS We identified 44 consecutive patients, who underwent supra-renal IVC resection with a mean age of 57.3 years. Isolated resection of IVC was performed in four patients, concomitant liver resection was performed in 27 patients and other associated resection in 13 patients. Total vascular exclusion was applied in 21 patients, isolated IVC occlusion in 11 patients. Neither venovenous bypass (VVB) nor hypothermic perfusion was used in any of the cases. RESULTS The mean operative time was 205 min (150-324 min) and the mean estimated blood loss was 755 ml (230-4500 ml). Overall morbidity was 59% and major complications (Dindo-Clavien ≥ III) occurred in 11 patients (25%). The 90-day mortality was 11% (5pts). Intraoperative haemotransfusion was significantly associated with postoperative general complications (p < 0,001). With a mean follow-up of 26.2 months, the actuarial 1-, 3- and 5-year survival is 69%, 34%, and 16%, respectively. CONCLUSIONS IVC resection and reconstruction in the aspect of aggressive surgical management of malignant disease confers a survival advantage in patients, often considered unresectable. When performed in experienced centres it is associated with acceptable morbidity and mortality.
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Szymczak M, Kaliciński PJ, Kowalewski G, Ciopiński M, Markiewicz-Kijewska M, Broniszczak D, Dembowska-Bagińska B, Kościesza A, Brzezińska-Rajszys G, Patkowski W, Stefanowicz M. Inferior Vena Cava and Venous Outflow Reconstruction in Living Donor Liver Transplantation in Children: A Single-Center Retrospective Study and Literature Review. Ann Transplant 2021; 26:e926217. [PMID: 33574216 PMCID: PMC7885297 DOI: 10.12659/aot.926217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background In this report, we present technical problems and solutions used in the reconstruction of the inferior vena cava and graft venous outflow during living donor liver transplantation (LDLT) in children. Material/Methods In 65 grafts out of 379 liver transplantations from living donors, reconstruction of multiple hepatic venous branches and/or IVC was necessary. In 4 cases, cryopreserved deceased donor venous grafts were used for the reconstruction of the IVC and/or HV. Results Follow-up ranged from 2 months to 17.8 years (median 7.2 years). In 4 children, liver re-transplantation was required for a reason not related to venous outflow (biliary complications in 3 patients, graft insufficiency caused by small-for-size syndrome). Two patients died: 1 due to tumor recurrence and 1 due to multi-organ failure. Fifty-nine patients are alive with good liver function. One patient (1.5%) after deceased donor venous graft reconstruction showed symptoms of venous outflow obstruction, which was successfully treated with endovascular balloon angioplasty and stent placement. The remaining 59 transplanted patients do not show any signs of venous outflow obstruction. Conclusions In most cases, the reconstruction of multiple hepatic veins of living donor allografts can successfully be done with local venoplasty, while using cold-stored vein grafts may be helpful in selected cases of LDLT.
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Affiliation(s)
- Marek Szymczak
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Piotr J Kaliciński
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Grzegorz Kowalewski
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Mateusz Ciopiński
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Dorota Broniszczak
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Andrzej Kościesza
- Department of Pediatric Radiology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Grażyna Brzezińska-Rajszys
- Department of Cardiology and Cardiovascular Interventional Laboratory, The Children's Memorial Health Institute, Warsaw, Poland
| | - Waldemar Patkowski
- Department of General, Transplant and Liver Surgery, Warsaw Medical University, Warsaw, Poland
| | - Marek Stefanowicz
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
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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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Baimas-George MR, Pickens RC, Sulzer JK, Vrochides D, Martinie JB, Levi DM, Iannitti DA. A ten-year experience of inferior vena cava reconstruction for malignancy: The importance of a multidisciplinary approach with hepatobiliary surgery. Hepatobiliary Pancreat Dis Int 2020; 19:396-398. [PMID: 32307281 DOI: 10.1016/j.hbpd.2020.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/18/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Maria R Baimas-George
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 600, Charlotte, NC 28204, USA
| | - Ryan C Pickens
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 600, Charlotte, NC 28204, USA
| | - Jesse K Sulzer
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 600, Charlotte, NC 28204, USA
| | - Dionisios Vrochides
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 600, Charlotte, NC 28204, USA
| | - John B Martinie
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 600, Charlotte, NC 28204, USA
| | - David M Levi
- Division of Transplant Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - David A Iannitti
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 600, Charlotte, NC 28204, USA.
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Djaladat H, Ghoreifi A, Basin MF, Hugen C, Aslzare M, Miranda G, Hwang DH, Schuckman AK, Aron M, Thangathurai D, Duddalwar V, Daneshmand S. Perioperative Outcome of Suprarenal Resection of Vena Cava Without Reconstruction in Urologic Malignancies: A Case Series and Review of the Literature. Urology 2020; 142:146-154. [PMID: 32339562 DOI: 10.1016/j.urology.2020.02.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe the feasibility and perioperative outcome of suprarenal resection of inferior vena cava (IVC) in urologic neoplasms without reconstruction. METHODS We retrospectively reviewed the patients who underwent suprarenal resection of IVC without reconstruction for urologic neoplasms in our institution between September 2010 and October 2019. Patients' demographic, clinical, radiologic, and 90-day perioperative complications were recorded. RESULTS Twenty-eight (79% male) patients with a median age of 59 (25-75) years were included in the study. Twenty-five (89%) of patients had renal cell carcinoma, 1 had renal leiomyosarcoma, and 2 had metastatic testicular teratoma. Twenty-two patients had Mayo level 3 thrombus, 3 had level 2, and 3 had level 4. The mean radiologic thrombus length was 12.6 cm. Eleven patients had radiologic bland thrombosis in the infrarenal IVC. Twenty-seven patients underwent open, and 1 robotic surgery. The median operating time was 411 (range 240-808) minutes, median blood loss was 3750 cc, and all but 1 patient received perioperative transfusion (median 11 units of packed red blood cells). Median hospital stay was 5 (3-50) days. Ninety-day complication rate was 35% (Clavien-Dindo grade I/II and III/IV were 21% and 14%, respectively). Four patients (14%) developed transient nondisabling leg edema. The 90-day mortality rate was 7%. CONCLUSION Suprarenal inferior vena cava resection without reconstruction is feasible, yet high-risk operation that should be performed in experienced centers in selected patients with urologic malignancies.
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Affiliation(s)
- Hooman Djaladat
- Institute of Urology, University of Southern California, Los Angeles, CA.
| | - Alireza Ghoreifi
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Michael F Basin
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Cory Hugen
- Institute of Urology, University of California Irvine, Irvine, CA
| | - Mohammad Aslzare
- Institute of Urology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gus Miranda
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Darryl H Hwang
- Department of Radiology, University of Southern California, Los Angeles, CA
| | - Anne K Schuckman
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Manju Aron
- Department of Pathology, University of Southern California, Los Angeles, CA
| | | | - Vinay Duddalwar
- Department of Radiology, University of Southern California, Los Angeles, CA
| | - Siamak Daneshmand
- Institute of Urology, University of Southern California, Los Angeles, CA
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Inferior Vena Cava Repair Using Diaphragm in Animal Model. Ann Vasc Surg 2020; 67:468-473. [PMID: 32179144 DOI: 10.1016/j.avsg.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Repair and reconstruction of the vena cava with an autologous vein requires multiple incisions. Prosthetic material is linked with an increased risk of infection and thrombosis. Therefore in this study, we created an animal model of vena cava repair using the diaphragm. The objective of this study is to assess the feasibility and outcomes of using diaphragm for the repair and replacement of the inferior vena cava (IVC) after resection of a part of the infrarenal IVC in an animal model, as it may be encountered in trauma patients and extensive tumors of retroperitoneum. METHODS Five healthy dogs of both sexes were prepared. After general anesthesia and laparotomy, a 1 cm width with 4 cm length defect was arranged on anterior aspect of the infrarenal IVC, subsequently, the anterior aspect of the right diaphragm with 1 cm width and 4 cm length was resected and was anastomosed to cover the defect of the IVC as a patch graft, with the pleural side of the diaphragm facing the luminal aspect and the peritoneal side on the outside. The observation period was 6 weeks. RESULTS All of the IVCs were macroscopically patent without thrombosis and stenosis. Pathologic assay revealed complete endothelialization of diaphragm. One dog died at the third night of operation without distinct reason. CONCLUSIONS The diaphragm is an accessible and safe option in the repair and reconstruction of IVC particularly when restrictions exist for the use of prosthetic material in a contaminated space of the abdomen.
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Inferior Vena Cava Resection and Reconstruction with Bovine Pericardium for Renal Cell Carcinoma: Complications and Outcomes. Urology 2019; 134:143-147. [PMID: 31542462 DOI: 10.1016/j.urology.2019.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/25/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess the postoperative complication rate and overall survival when bovine pericardium is used as graft material for inferior vena cava (IVC) reconstructions in patients with renal cell carcinoma (RCC). The ideal graft material is yet to be established, with synthetic grafts widely studied and used in the current literature. METHODS We performed a retrospective cohort analysis of consecutive patients who underwent IVC reconstructions as part of resection for RCC, using bovine pericardium as either a patch repair or tubular interposition graft. RESULTS A total of 15 patients underwent resection with IVC reconstruction between 2010 and 2018. Nine patients had tubular interposition grafts and 6 had patch repairs. Three patients had Clavien-Dindo grade 3 or higher short-term complications. There was no difference in Comprehensive Complications Index between those who had interposition grafts and patch repairs. Two patients had a long-term graft-associated thrombus requiring temporary anticoagulation. Overall survival was 46.5 months (95% confidence interval [CI] 36.9-56.1). There were no perioperative deaths. All long-term deaths were due to disease progression. CONCLUSION Reconstruction of the IVC with a bovine pericardium graft is safe in experienced centers. Bovine pericardium could be considered as the material of choice, given its safety in the immediate postoperative period, ease of use, and patency without routine long-term anticoagulation. Advanced surgical management leads to good overall survival in this cohort with high tumor burden.
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One-step reconstruction of IVC and right hepatic vein using reversed auto IVC and left renal vein graft. Int J Surg Case Rep 2019; 57:57-59. [PMID: 30903855 PMCID: PMC6430719 DOI: 10.1016/j.ijscr.2019.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/23/2019] [Accepted: 03/05/2019] [Indexed: 01/04/2023] Open
Abstract
The left liver lobe was resected including the tumor and IVC ex vivo, and the right hepatic vein were reconstructed using the reversed patient’s left renal vein (LRV) and IVC graft. The patient’s right liver lobe with the reversed LRV/IVC graft was transplanted back into the patient using a partial liver transplant technique.
Introduction A malignant tumor invading the inferior vena cava (IVC) and concomitant with 3 hepatic venous involvement still remains surgical therapeutic challenge. Presentation of case A 79-year-old male presented with liver dysfunction and was eventually diagnosed with an intrahepatic huge IHCC originating at the level of confluence of 3 hepatic veins to the IVC, extending to the right hepatic vein (HV). Under extracorporeal circulation, the liver with the IVC, portal vein, hepatic artery and common bile duct were removed en bloc. In the back table, the left liver lobe was resected including the tumor and IVC, and the right HV was reconstructed using the patient’s reversed left renal vein (LRV) and IVC graft. Subsequently, the patient’s right liver lobe with the reversed LRV/IVC graft was transplanted back into the patient using a partial liver transplant technique. Liver enzymes gradually came down to the value within normal range on postoperative day 13 with the patency of the right HV. However, the patient expired on POD 16 because of sudden septic complications. Discussion This technique could be one of the options to reconstruct the HV/IVC when a tumor invades all 3 HVs. Conclusion To the best of our knowledge, this is the first report of such HV reconstruction in combination with extracorporeal resection of huge liver cancer in updated world literature.
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Papamichail M, Marmagkiolis K, Pizanias M, Koutserimpas C, Heaton N. Safety and Efficacy of Inferior Vena Cava Reconstruction During Hepatic Resection. Scand J Surg 2018; 108:194-200. [DOI: 10.1177/1457496918798213] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background and Aims: Patients with liver tumors involving the inferior vena cava have a poor outcome without surgery. Liver resection en bloc with inferior vena cava resection and reconstruction is now performed in many centers. The purpose of this study is to investigate the safety and efficacy of inferior vena cava reconstruction during hepatic resection. Materials and Methods: A review of 12 centers reporting 240 patients with combined hepatectomy and inferior vena cava resection and reconstruction for malignant tumors was performed. Sample size, patient characteristics, histological type of the tumor, method of reconstruction, complications, and long-term survival (1-, 2-, and 5-year survival) were evaluated. Results: A total of 240 patients from 12 institutions (male 58%) with mean age 54 years underwent combined liver resection and inferior vena cava resection and reconstruction for colorectal liver metastases (43%), cholangiocarcinomas (26%), hepatocellular carcinomas (19%), leiomyosarcomas (4%), and other tumors (7.9%). Reconstruction included primary closure (35.8%), patch repair (13.3%), or interposition graft (50.8%) In-hospital mortality was 6.25% and overall morbidity was 42.1%. 1- and 10-year survival rates were 79.7% and 28.9%, respectively. Conclusion: Tumors arising in or extending to inferior vena cava that require liver resection should be considered for surgery as it can be performed with an acceptable mortality and morbidity in centers with liver transplantation and hepato-pancreato-biliary facilities.
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Affiliation(s)
- M. Papamichail
- Department of Transplantation and Hepatopancreatobiliary Surgery, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - K. Marmagkiolis
- Department of Interventional Cardiology, Premier Heart and Vascular Group, Pepin Heart Institute, Florida Hospital, Tampa, FL, USA
| | - M. Pizanias
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver Studies, Kings Health Partners at King’s College Hospital NHS Trust, London, UK
| | - C. Koutserimpas
- 2nd Department of General Surgery, Sismanogleio General Hospital, Athens, Greece
| | - N. Heaton
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver Studies, Kings Health Partners at King’s College Hospital NHS Trust, London, UK
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15
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Angelico R, Passariello A, Pilato M, Cozzolino T, Piazza M, Miraglia R, D'Angelo P, Capasso M, Saffioti MC, Alberti D, Spada M. Ante situm liver resection with inferior vena cava replacement under hypothermic cardiopolmunary bypass for hepatoblastoma: Report of a case and review of the literature. Int J Surg Case Rep 2017. [PMID: 28651228 PMCID: PMC5485760 DOI: 10.1016/j.ijscr.2017.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Hepatoblastoma with tumour thrombi extending into inferior-vena-cava and right atrium are often unresectable with an extremely poor prognosis. The surgical approach is technically challenging and might require major liver resection with vascular reconstruction and extracorporeal circulation. However, which is the best surgical technique is yet unclear. PRESENTATION OF CASE A 11-months-old boy was referred for a right hepatic lobe mass(90×78mm) suspicious of hepatoblastoma with tumoral thrombi extending into the inferior-vena-cava and the right atrium, bilateral lung lesions and serum alpha-fetoprotein level of 50.795IU/mL. After 8 months of chemotherapy (SIOPEL 2004-high-risk-Protocol), the lung lesions were no longer clearly visible and the hepatoblastoma size decreased to 61×64mm. Thus, ante situm liver resection was planned: after hepatic parenchymal transection, hypothermic cardiopulmonary bypass was started and en bloc resection of the extended-right hepatic lobe, the retro/suprahepatic cava and the tumoral trombi was performed with concomitant cold perfusion of the remnant liver. The inferior-vena-cava was replaced with an aortic graft from a blood-group compatible cadaveric donor. The post-operative course was uneventful and after 8 months of follow-up the child has normal liver function and an alpha-fetoprotein level and is free of disease recurrence with patent vascular graft. CONCLUSIONS We report for the first time a case of ante situ liver resection and inferior-vena-cava replacement associated with hypothermic cardiopulmonary bypass in a child with hepatoblastoma. Herein, we extensively review the literature for hepatoblastoma with thumoral thrombi and we describe the technical aspects of ante situm approach, which is a realistic option in otherwise unresectable hepatoblastoma.
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Affiliation(s)
- Roberta Angelico
- Department of Abdominal Transplantation and Hepatobiliary and Pancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Annalisa Passariello
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy; Department of Pediatric Oncology, Ospedale Santobono- Pausilipon, Naples, Italy.
| | - Michele Pilato
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.
| | - Tommaso Cozzolino
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
| | - Marcello Piazza
- Department of Anesthesia and Intensive Care, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.
| | - Roberto Miraglia
- Radiology Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.
| | - Paolo D'Angelo
- "Giovanni Di Cristina" Children's Hospital, Pediatric Hematology and Oncology, Palermo, Italy.
| | - Mariella Capasso
- Department of Pediatric Oncology, Ospedale Santobono- Pausilipon, Naples, Italy.
| | - Maria Cristina Saffioti
- Department of Abdominal Transplantation and Hepatobiliary and Pancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Daniele Alberti
- Department of Pediatric Surgery, "Spedali Civili" Children's Hospital, Brescia, Italy.
| | - Marco Spada
- Department of Abdominal Transplantation and Hepatobiliary and Pancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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16
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Hodjati H, Hoseinzadeh A, Mousavi SM, Dehghani Nazhavi S, Kumar V, Sehhatpour M. Inferior Vena Cava Repair Using Serosal Patch of Small Bowel: An Experimental Study. Bull Emerg Trauma 2017; 5:24-28. [PMID: 28246620 PMCID: PMC5316133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 11/29/2016] [Accepted: 12/05/2016] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE To evaluate the feasibility and results of using serosal patch of small bowel for repair and replacement of inferior vena cava (IVC) after resection of a part of infra-renal IVC in an animal model, as it may be encountered in extensive tumors of retroperitoneal and trauma patients. METHODS Five healthy sheep of both sexes were prepared. After general anesthesia and laparotomy, a defect with 1 cm width and 4cm length was made on anterior aspect of infra-renal IVC, and then an adjacent loop of small bowel was brought and sutured continuously to cover the defect of IVC as a patch graft. The observation period was two months. RESULTS Three of five IVCs were macroscopically patent without stenosis and thrombosis. Pathologic assay revealed complete endothelialization of serosal surface of the patch of small bowel loop. One of IVCs was completely occluded in gross evaluation and fibrous formation in pathologist review. The sheep had no sign of venous hypertension and edema of limbs. One sheep died at the night of first operation due to internal bleeding. CONCLUSION Serosal patch of small bowel is an accessible and feasible alternative in repair and reconstruction of IVC especially when there is restriction for use of prosthetic material in a contaminated space of abdomen.
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Affiliation(s)
- Hossein Hodjati
- Department of Vascular Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Hoseinzadeh
- Department of Vascular Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Masoud Mousavi
- Department of Vascular Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Viginda Kumar
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Sehhatpour
- Department of Psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran
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17
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Wang J, Cheng Y, Lee YZ, Wang Y, Zheng Y, Dong R, Lai Y, Tang X, Yang Y, Wang S, He N, Jia Y, Cheng W, Liu D, Wang X, Zhang C. Sonography and Transthoracic Echocardiography for Diagnosis of Systemic Cardiovascular Metastatic Tumor Thrombi. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1993-2027. [PMID: 27492390 DOI: 10.7863/ultra.15.10038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/23/2015] [Indexed: 06/06/2023]
Abstract
Sonography and transthoracic echocardiography (TTE) are seldom used for assessment of metastatic tumor thrombi in the cardiovascular system in routine clinical practice. We performed this retrospective study to evaluate the combination of sonography with TTE for diagnosis of metastatic tumor thrombi in heart and systemic vessels. Vascular, abdominal, pelvic, and small-part sonography was applied in 18 patients, and TTE was conducted simultaneously in 14 patients. Tumor thrombi invaded into the inferior vena cava system in 12 patients, superior vena cava system in 5 patients, and aorta in 1 patient; they extended to the right cardiac chambers in 11 patients. Six patients had diagnoses by pathologic examination. The primary neoplasms were identified by conventional imaging in 17 patients. The morphologic and echogenic characteristics of the tumor thrombi were diverse and depended on their original tumors. The thrombi were either contiguous or discrete from the original tumors. The neoplastic vascularity of the thrombi and the invasive extension were the primary characteristics that distinguished them from bland thrombi. Simultaneous application of sonography and TTE is a feasible way to comprehensively evaluate cardiovascular metastatic tumor thrombi in most patients.
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Affiliation(s)
- Jiong Wang
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China, Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina USA, Department of Medical Ultrasonography, Peking University International Hospital, Beijing, China
| | - Yi Cheng
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yueh Z Lee
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina USA
| | - Yongmei Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Ye Zheng
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yongqiang Lai
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xiaobin Tang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yaoguo Yang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Sheng Wang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Nan He
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yunfeng Jia
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Wei Cheng
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Dan Liu
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xiaona Wang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Chun Zhang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
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18
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Hsu SC, Jeng LB, Thorat A, Li PC, Poon KS, Hsu CH, Yeh CC, Chen TH, Yang HR. Management of extensive retrohepatic vena cava defect in recipients of living donor liver transplantation. Transplant Proc 2015; 46:699-704. [PMID: 24767328 DOI: 10.1016/j.transproceed.2013.11.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/07/2013] [Indexed: 01/03/2023]
Abstract
Certain complexities, such as extensive vena caval injury, unexpected dense adhesions between liver and retrohepatic vena cava, and liver tumor abutting retrohepatic vena cava, sometimes warrant resection of vena cava during living-donor liver transplantation. Because the donor graft is devoid of vena cava, reconstruction of the retrohepatic cava is required, which can be done with the use of either a cryopreserved venous graft or an artificial conduit. With only a few published reports, the experience in vena cava reconstruction with the use of expanded polytetrafluoroethylene (ePTFE) during living-donor liver transplantation remains limited. We present our experience of 4 patients who successfully underwent vena caval resection during liver transplantation for various indications, which was subsequently reconstructed with the use of ePTFE grafts. All of these patients except 1 recovered well without any undue complications, such as thrombosis or outflow inadequacies, thus proving this extensive surgical treatment to be a successful and life-saving procedure, though meticulous skills are prerequisite.
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Affiliation(s)
- S-C Hsu
- Department of Surgery, China Medical University, Taichung, Taiwan; Organ Transplantation Center, China Medical University, Taichung, Taiwan
| | - L-B Jeng
- Department of Surgery, China Medical University, Taichung, Taiwan; Organ Transplantation Center, China Medical University, Taichung, Taiwan; China Medical University Hospital, China Medical University, Taichung, Taiwan.
| | - A Thorat
- Organ Transplantation Center, China Medical University, Taichung, Taiwan
| | - P-C Li
- Department of Surgery, China Medical University, Taichung, Taiwan; Organ Transplantation Center, China Medical University, Taichung, Taiwan; China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - K-S Poon
- Department of Anesthesiology, China Medical University, Taichung, Taiwan
| | - C-H Hsu
- Department of Surgery, China Medical University, Taichung, Taiwan; Organ Transplantation Center, China Medical University, Taichung, Taiwan
| | - C-C Yeh
- Department of Surgery, China Medical University, Taichung, Taiwan; Organ Transplantation Center, China Medical University, Taichung, Taiwan; China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - T-H Chen
- Department of Surgery, China Medical University, Taichung, Taiwan; Organ Transplantation Center, China Medical University, Taichung, Taiwan
| | - H-R Yang
- Department of Surgery, China Medical University, Taichung, Taiwan; Organ Transplantation Center, China Medical University, Taichung, Taiwan; China Medical University Hospital, China Medical University, Taichung, Taiwan
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19
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Pulitanó C, Crawford M, Ho P, Gallagher J, Joseph D, Stephen M, Sandroussi C. The use of biological grafts for reconstruction of the inferior vena cava is a safe and valid alternative: results in 32 patients in a single institution. HPB (Oxford) 2013; 15:628-32. [PMID: 23458108 PMCID: PMC3731585 DOI: 10.1111/hpb.12029] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 10/17/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Resection and reconstruction of the inferior vena cava (IVC) is occasionally required in the surgical treatment of intra-abdominal tumours. IVC reconstruction can be performed with biological or synthetic graft material, with most centres preferring synthetic grafts. In spite of the potential advantages of biological grafts in terms of handling characteristics, and safety, very limited data are available about their use in patients requiring an IVC resection. METHODS Medical records of 32 patients who underwent an IVC resection and reconstruction from 1990 and 2011 with autogenous peritoneo-fascial (N = 22) and bovine pericardial (N = 10) grafts were reviewed. RESULTS A tangential resection with patch repair was performed in 10 patients, whereas in the remaining 22 it was necessary to resect and replace a segment or all of the retrohepatic IVC. A concomitant liver resection was performed in 14 patients, nephrectomy in 10 and pancreaticoduodenectomy in 2 patients. There were no acute or late complications related to graft thrombosis or infection. Three patients died as a consequence of multi-organ failure. Overall survival at 1 and 5 years was 78% and 48%, respectively. CONCLUSIONS The preferential use of synthetic grafts in IVC replacement is not evidence based. Selection of an appropriate prosthetic graft for IVC reconstruction should be based on the safety and its handling features. The use of biological grafts for IVC repair is a valid alternative to current synthetic materials and may in fact be superior in terms of biocompatability, ease of handling, reduced rate of infection and improved long-term patency without permanent anticoagulation.
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Affiliation(s)
- Carlo Pulitanó
- Upper Gastrointestinal and Hepatobiliary Surgery. Royal Prince Alfred HospitalSydney, NSW, Australia
| | - Michael Crawford
- Upper Gastrointestinal and Hepatobiliary Surgery. Royal Prince Alfred HospitalSydney, NSW, Australia
| | - Phong Ho
- Upper Gastrointestinal and Hepatobiliary Surgery. Royal Prince Alfred HospitalSydney, NSW, Australia
| | - James Gallagher
- Upper Gastrointestinal and Hepatobiliary Surgery. Royal Prince Alfred HospitalSydney, NSW, Australia
| | - David Joseph
- Upper Gastrointestinal and Hepatobiliary Surgery. Royal Prince Alfred HospitalSydney, NSW, Australia
| | - Michael Stephen
- Upper Gastrointestinal and Hepatobiliary Surgery. Royal Prince Alfred HospitalSydney, NSW, Australia
| | - Charbel Sandroussi
- Upper Gastrointestinal and Hepatobiliary Surgery. Royal Prince Alfred HospitalSydney, NSW, Australia,University of Sydney, Surgical Outcomes Research Centre (SOurCe)Sydney, NSW, Australia
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20
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Hemming AW, Mekeel KL, Zendejas I, Kim RD, Sicklick JK, Reed AI. Resection of the liver and inferior vena cava for hepatic malignancy. J Am Coll Surg 2013; 217:115-24; discussion 124-5. [PMID: 23376028 DOI: 10.1016/j.jamcollsurg.2012.12.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 12/04/2012] [Accepted: 12/05/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Involvement of the IVC has traditionally been considered a relative contraindication to resection for advanced tumors of the liver. Combined resection of the liver and IVC for malignancy can be performed safely and results in long-term survival in select patients. STUDY DESIGN Sixty patients undergoing hepatic and IVC resection by the primary author from 1996 to 2012 were reviewed. Median age was 52 years. Resections were carried out for cholangiocarcinoma (n = 26), hepatocellular carcinoma (n = 16), colorectal metastases (n = 13), gastrointestinal stromal tumor (n = 2), hepatoblastoma (n = 2), and squamous cell carcinoma (n = 1). Resections performed included 27 right and 5 left trisegmentectomies and 25 right and 3 left lobectomies, including the caudate lobe. Ex vivo procedures were performed in 6 patients using veno-venous bypass and the other 54 procedures were performed using varying degrees of vascular isolation. In situ cold perfusion of the liver was used in 8 patients. The IVC was reconstructed using a tube graft (n = 38) primarily (n = 8) or with patches (n = 14). RESULTS There were 5 perioperative deaths (8%). Three patients died of liver failure, 1 patient died of pulmonary hemorrhage, and 1 patient died of massive pulmonary embolism. Nine patients had evidence of postoperative liver failure that resolved with supportive management. Three patients required temporary dialysis. With a median follow-up of 31 months, 14 patients have died of recurrent malignancy between 22 and 44 months, and an additional 4 patients are alive with disease at 16 to 33 months. Actuarial 1- and 5-year survival rates were 89% and 35%, respectively. CONCLUSIONS Inferior vena cava involvement by malignancy does not obviate liver resection. The procedure's increased risk is balanced by the possible benefits, given the lack of alternative curative approaches.
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Affiliation(s)
- Alan W Hemming
- Department of Surgery, Center for Hepatobiliary Diseases, University of California San Diego, San Diego, CA 92103-8401, USA.
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