Ex vivo liver resection and autotransplantation (ELRA) in extensive abdominal alveolar echinococcosis (AE) is a relatively rare treatment. We present the first case, ever reported in Kazakhstan, of successfully performed ELRA of a patient with extensive abdominal AE with invasion into the inferior vena cava (IVC). A 64-year-old woman was diagnosed with AE of the brain, alveococcectomy from the left frontal lobe was performed. At the same time, liver AE metastased to the lungs and brain was diagnosed. The patient was admitted to our center for the following surgical treatments: (1) laparotomy, (2) extended left hemihepatectomy with resection of IVC ex vivo, (3) plastic surgery of IVC with a synthetic prosthesis, (4) orthotopic transplantation of the remnant right lobe of the liver. The postoperative period proceeded smoothly. The patient was mechanically ventilated for 1.5 days and prescribed strict bed rest with in-bed activity for up to 11 days. Empirical antibiotic therapy was initiated as follows: meropenem 1000 mg three times a day for 10 days, omeprazole 40 mg once a day for 14 days, anticoagulant therapy was not administered in the first post-operation day due to high risk of bleeding. Clexane was prescribed subcutaneously once a day: 0.2 mL for 2 days, then 0.4 mL for next 10 days. Daily transfusion of 100 mL of 10% Albumin was performed to prevent hypoalbuminemia. Drainage systems were removed on the 9th day. On the 12th day, the patient was transferred from the intensive care unit to a hospital room, and discharged with improvement on the 20th day. During a 6-month follow-up, no relapse was observed. Radical surgery for widespread AE, in this case - ELRA, is the preferred treatment, since it does not require immunosuppressive therapy and is quite feasible even with invasion of the portal vein bifurcation, IVC and hepatocaval confluence.

Echinococcosis or hydatid disease is induced mainly by Echinococcus granulosus and occasionally by Echinococcus multilocularis (alveolaris) and affects the liver predominantly. Hepatic alveolar echinococcosis is similar to carcinoma in appearance, and without treatment, it can lead to death. Diagnosis is based on current imaging modalities. Surgical management is the cornerstone of treatment. Complete removal of the cyst (total pericystectomy or hepatectomy) ensures a permanent cure and should be the first-choice treatment for cystic disease. Cyst evacuation, partial cystectomy, and drainage or omentoplasty, may be alternative choices in difficult cases. Albendazole, mebendazole and praziquantel are options for treating small cysts and preventing recurrence after surgery. Despite the efforts, alveolar echinococcus is not usually amenable to surgical management, except in the early stage, which is less common, and management by albendazole is indicated. However, there are few recent reports of major operations (ex-vivo hepatectomy, autotransplantation and vascular reconstruction) in advanced stages.

As tumors invade major abdominal veins, surgical procedures are transformed from simple and basic to complicated and challenging. In this narrative review, we focus on what is currently known and not known regarding the technical aspects of major abdominal venous resection and its reconstruction, patency, and oncologic benefit in a cross-cutting perspective.

A systematic literature search was performed in PubMed and Semantic Scholar from inception up to October 18, 2023. We reviewed 106 papers by title, abstract, and full text regarding resection or reconstruction of the inferior vena cava, hepatic vein confluence, portal vein (PV), and middle hepatic vein (MHV) tributaries in living donor liver transplantation (LDLT) in a cross-cutting perspective.

The oncologic benefit of aggressive hepatic vein resection with suitable reconstruction against adenocarcinoma remains unclear, and further studies are required to clarify this point. A superior mesenteric/PV resection is now a universal, indispensable, and effective procedure for pancreatic ductal adenocarcinoma. Although many case series using tailor-made autologous venous grafts have been reported, not only size mismatch but also additional surgical incisions and a longer operation time remain obstacles for venous reconstruction. The use of autologous alternative tissue remains only an alternative procedure because the patency rate of customized tubular conduit type to interpose or replace the resected vein is not known. Unlike arterial replacement, venous replacement using synthetic vascular grafts is still rarely reported and there are several inherent limitations except for reconstruction of tributaries of MHV in LDLT.

Various approaches to abdominal vein resection and replacement or reconstruction are technically feasible with satisfactory results. Synthetic vascular grafts may be appropriate but have a certain rate of complications.

The presence of a cysto-caval fistula is a serious and rare complication of hepatic hydatid cysts, which can be life-threatening. We report a case of a 22-year-old patient with a segment I hepatic hydatid cyst discovered following scannographic imaging for non-specific abdominal pain. Management consisted of albendazole-based premedication for two weeks, followed by hepatic and venous resection surgery with prosthetic replacement after venous exclusion under extracorporeal circulation. To avoid hemorrhagic and/or embolic complications, it is essential to discuss rare cases of hydatid cysts with intimate contact or invasion of the vena cava in a multidisciplinary setting, to plan repair or reconstruction away from intraoperative surprises that are often fatal for benign pathology.