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Di Benedetto F, Magistri P, Marcon F, Soubrane O, Pedreira Mello F, Santos Coelho J, Fernandez AR, Frassoni S, Bagnardi V, Singhal A, Rotellar F, Hernandez-Alejandro R, Alikhanov R, de Souza M Fernandes E, Cauchy F, Muiesan P, Di Sandro S, Pinto Marques H. Vena cava replacement and major hepatectomy for liver tumors: international multicenter retrospective cohort study. Int J Surg 2024; 110:4286-4296. [PMID: 38608195 PMCID: PMC11254261 DOI: 10.1097/js9.0000000000001386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/11/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Involvement of the inferior vena cava (IVC) and hepatic veins has been considered a relative contraindication to hepatic resection for primary and metastatic liver tumors. However, patients affected by tumors extending to the IVC have limited therapeutic options and suffer worsening of quality of life due to IVC compression. METHODS Cases of primary and metastatic liver tumors with vena cava infiltration from 10 international centers were collected (7 European, 1 US, 2 Brazilian, 1 Indian) were collected. Inclusion criteria for the study were major liver resection with concomitant vena cava replacement. Clinical data and short-term outcomes were analyzed. RESULTS Thirty-six cases were finally included in the study. Median tumor max size was 98 mm (range: 25-250). A biliary reconstruction was necessary in 28% of cases, while a vascular reconstruction other than vena cava in 34% of cases. Median operative time was 462 min (range: 230-750), with 750 median ml of estimated blood loss and a median of one pRBC transfused intraoperatively (range: 0-27). Median ICU stay was 4 days (range: 1-30) with overall in-hospital stay of 15 days (range: 3-46), postoperative CCI score of 20.9 (range: 0-100), 12% incidence of PHLF grade B-C. Five patients died in a 90-days interval from surgery, one due to heart failure, one due to septic shock, and three due to multiorgan failure. With a median follow-up of 17 months (interquartile range: 11-37), the estimated 5 years overall survival was 48% (95% CI: 27-66%), and 5-year cumulative incidence of tumor recurrence was 55% (95% CI: 33-73%). CONCLUSIONS Major liver resections with vena cava replacement can be performed with satisfactory results in expert HPB centers. This surgical strategy represents a feasible alternative for otherwise unresectable lesions and is associated with favorable prognosis compared to nonoperative management, especially in patients affected by intrahepatic cholangiocarcinoma.
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Affiliation(s)
- Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Marcon
- HPB Surgery and Liver Transplant, Queen Elizabeth Hospital, Birmingham, UK
| | - Olivier Soubrane
- Department of HPB and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - Felipe Pedreira Mello
- Department of Surgery and Abdominal Organ Transplantation – Hospital Adventista Silvestre, Rio de Janeiro, Brazil
| | - Joao Santos Coelho
- Department of Surgery, Hepato-Biliary-Pancreatic and Transplantation Center, Curry Cabral Hospital, Lisbon, Portugal
| | - Andre Renaldo Fernandez
- Department of Surgery, Division of Transplantation and Hepatobiliary Surgery, University of Rochester Medical Center, Rochester, New York
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Ashish Singhal
- Advanced Institute of Liver and Biliary Sciences, Fortis Hospitals, Delhi, NCR, India
| | - Fernando Rotellar
- Department of Surgery, HPB and Liver Transplantation Unit, University Clinic, Universidad de Navarra; Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Roberto Hernandez-Alejandro
- Department of Surgery, Division of Transplantation and Hepatobiliary Surgery, University of Rochester Medical Center, Rochester, New York
| | - Ruslan Alikhanov
- Department of Hepato-Pancreato-Biliary Surgery and Department of Transplantation, Moscow Clinical Scientific Center, Moscow, Russia
| | - Eduardo de Souza M Fernandes
- Department of Surgery and Abdominal Organ Transplantation – Hospital Adventista Silvestre, Rio de Janeiro, Brazil
- Hepato-Pancreato-Biliary Unit and Transplant – DHR Health, McAllen, Texas, USA
| | - Francois Cauchy
- Department of HPB and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - Paolo Muiesan
- HPB Surgery and Liver Transplant, Queen Elizabeth Hospital, Birmingham, UK
| | - Stefano Di Sandro
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Hugo Pinto Marques
- Department of Surgery, Hepato-Biliary-Pancreatic and Transplantation Center, Curry Cabral Hospital, Lisbon, Portugal
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Smith EN, Coleman A, J. Galgano S, Burgan CM, Porter KK. Cholangiocarcinoma. ONCOLOGIC IMAGING : A MULTIDISCIPLINARY APPROACH 2023:133-159. [DOI: 10.1016/b978-0-323-69538-1.00011-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Li X, Li B, Zhang N, Wang F, Zhang C, Sun N, Zhang J. Case report: Reconstruction of the left renal vein with resected autologous right renal vein interposition after excision of an inferior vena cava leiomyosarcoma. Front Surg 2022; 9:913927. [PMID: 35959128 PMCID: PMC9362845 DOI: 10.3389/fsurg.2022.913927] [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] [Received: 04/12/2022] [Accepted: 07/11/2022] [Indexed: 12/01/2022] Open
Abstract
Background Leiomyosarcoma of the inferior vena cava (IVC) was a rather rare disease with the characteristics of invading the adjacent viscera. Surgical resection is the only potential curative treatment, and radiation therapy and chemotherapy for leiomyosarcoma are not definite. There is few literature reporting the leiomyosarcoma of the IVC. Case presentation A previously healthy 64-year-old female was admitted to the First Affiliated Hospital of China Medical University with the complaint of right lower quadrant abdominal pain for almost three years and worsening with a radiating ache in the waist recently. Contrast-enhanced computed tomography(CT) scans revealed a large (7.8 cm*5.5 cm*5.0 cm) irregular hypodense retroperitoneal mass with heterogeneous enhancement and invasion of the IVC, and the right ureter was compressed with proximal ureteral dilatation and hydrops. Three-dimensional CT of the IVC revealed that the IVC was encircled by the tumor with moderate invasion. During the operation, the tumor was resected en bloc with the IVC (from the suprarenal to infrarenal segment), the right kidney with ureter, and the duodenum seromuscular layer. As the left renal vein was involved, it was also partly resected. IVC reconstruction was performed with the interposition of a 20 mm diameter polytetrafluoroethylene (PTFE) prosthesis, and the right renal vein was anastomosed between the left renal vein and the reconstructed IVC to guarantee the left renal vein reflux. The patient had an uneventful recovery process with normal renal function after the operation. However, follow-up CT indicated that the left renal vein was blocked two weeks after the surgery. The patient was discharged two weeks after the operation. She continues well and has no evidence of disease fourteen months after the surgery. Conclusions Wide excision of the tumor en bloc with the IVC is the main treatment for leiomyosarcoma of the IVC. IVC reconstruction with prosthetic PTFE grafts is recommended. When the left renal vein is partly resected due to involvement of the tumor, reconstruction of left renal vein should also be performed to avoid renal impairment. If the right renal vein does not show tumor involvement, the resected right renal vein can be used to reconstruct the left renal vein.
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Schullian P, Johnston E, Laimer G, Scharll Y, Putzer D, Eberle G, Kolbitsch C, Amann A, Stättner S, Bale R. Stereotactic radiofrequency ablation of tumors at the hepatic venous confluence. HPB (Oxford) 2022; 24:1044-1054. [PMID: 34887174 DOI: 10.1016/j.hpb.2021.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/30/2021] [Accepted: 11/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is subject to "heat-sink" effects, particularly for treatment of tumors adjacent to major vessels. METHODS In this retrospective study, 104 patients with 137 tumors (40 HCC, 10 ICC and 54 metastatic liver tumors) close to (≤1 cm from) the hepatic venous confluence underwent stereotactic RFA (SRFA) between June 2003 and June 2018. Median tumor size was 3.7 cm (1.4-8.5) for HCC, 6.4 cm (0.5-11) for ICC and 3.8 cm (0.5-13) for metastases. Endpoints comprised safety, local tumor control, overall and disease-free survival. RESULTS The overall major complication rate was 16.0% (20/125 ablations), where 8 (40%) were successfully treated by the interventional radiologist in the same anesthetic session and did not prolong hospital stay. 134/137 (97.8%) tumors were successfully ablated at initial SRFA. Local recurrence (LR) developed in 19/137 tumors (13.9%). The median and overall survival (OS) rates at 1-, 3-, and 5- years from the date of the first SRFA were 51.5 months, 73.5%, 67.0%, and 49.7% for HCC, 14.6 months, 60.0%, 32.0% and 32.0% for ICC and 38.1 months, 91.4%, 56.5% and 27.9% for metastatic disease, respectively. CONCLUSION SRFA represents a viable alternative to hepatic resection for challenging tumors at the hepatic venous confluence.
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Affiliation(s)
- Peter Schullian
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Edward Johnston
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK
| | - Gregor Laimer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Yannick Scharll
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gernot Eberle
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Christian Kolbitsch
- Department of Anesthesia, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Arno Amann
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck Austria
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Salzkammergut Klinikum, D.Wilhelm Bock Strasse 1, 4840, Vöcklabruck Austria; Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Radulova-Mauersberger O, Weitz J, Riediger C. Vascular surgery in liver resection. Langenbecks Arch Surg 2021; 406:2217-2248. [PMID: 34519878 PMCID: PMC8578135 DOI: 10.1007/s00423-021-02310-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/18/2021] [Indexed: 01/04/2023]
Abstract
Vascular surgery in liver resection is a standard part of liver transplantation, but is also used in oncological liver surgery. Malignant liver tumors with vascular involvement have a poor prognosis without resection. Surgery is currently the only treatment to provide long-term survival in advanced hepatic malignancy. Even though extended liver resections are increasingly performed, vascular involvement with need of vascular reconstruction is still considered a contraindication for surgery in many institutions. However, vascular resection and reconstruction in liver surgery-despite being complex procedures-are safely performed in specialized centers. The improvements of the postoperative results with reduced postoperative morbidity and mortality are a result of rising surgical and anesthesiological experience and advancements in multimodal treatment concepts with preconditioning measures regarding liver function and systemic treatment options. This review focuses on vascular surgery in oncological liver resections. Even though many surgical techniques were developed and are also used during liver transplantation, this special procedure is not particularly covered within this review article. We provide a summary of vascular reconstruction techniques in oncological liver surgery according to the literature and present also our own experience. We aim to outline the current advances and standards in extended surgical procedures for liver tumors with vascular involvement established in specialized centers, since curative resection improves long-term survival and shifts palliative concepts to curative therapy.
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Affiliation(s)
- Olga Radulova-Mauersberger
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.
- German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany.
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Carina Riediger
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
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Bacalbasa N, Balescu I, Ichim F, Barbu I, Ristea A, Lazea R, Danciuc I, Popa I, Magdoiu O, Smira G, Diaconu C, Furtunescu F, Stiru O, Savu C, Stoica C, Brasoveanu V, Ursut B, Al Aloul A. Major Hepatectomy En Bloc with Cava Vein Resection for Locally Invasive Caudate Lobe Hepatocarcinoma. Healthcare (Basel) 2021; 9:1396. [PMID: 34683076 PMCID: PMC8535728 DOI: 10.3390/healthcare9101396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/AIM Locally advanced liver tumours with vascular invasion have been considered for a long period of time as unresectable lesions, so the patient was further deferred to oncology services for palliation. However, improvement of the surgical techniques and the results reported so far came to demonstrate that extended hepatic and vascular resections might be safely performed in such cases and might significantly improve the long-term outcomes. MATERIALS AND METHODS A 61-year-old patient was diagnosed with a caudate lobe tumour invading the inferior cava vein and the right hepatic pedicle. RESULTS The patient was successfully submitted to surgery, and an extended right hepatectomy en bloc with cava vein resection was performed; the continuity of the cava vein was re-established by the placement of a synthetic graft. The postoperative outcome was uneventful. CONCLUSIONS Although initially considered as a formal contraindication for resection, vascular invasion of the greater vessels should not preclude surgery if complete resection is achievable.
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Affiliation(s)
- Nicolae Bacalbasa
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, “Ponderas” Academic Hospital, 014142 Bucharest, Romania;
| | - Florin Ichim
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
| | - Ion Barbu
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
| | - Alexandru Ristea
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
| | - Razvan Lazea
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
| | - Ioana Danciuc
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
| | - Ioana Popa
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
| | - Ovidiu Magdoiu
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
| | - Gabriela Smira
- Department of Gastroenterology, “Fundeni” Clinical Institute, 022328 Bucharest, Romania;
| | - Camelia Diaconu
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Florentina Furtunescu
- Department of Public Health and Management, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania;
| | - Ovidiu Stiru
- Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
- Department of Cardio-Thoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cornel Savu
- Department of Thoracic Surgery, “Marius Nasta” National Institute of Pneumology, 050159 Bucharest, Romania;
- Department of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Claudia Stoica
- Department of Surgery, Ilfov County Hospital, 077160 Bucharest, Romania;
- Department of Anatomy, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Vladislav Brasoveanu
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
| | - Bogdan Ursut
- Department of Anatomy, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Surgery, Emergency Hospital “Agrippa Ionescu”, 011356 Bucharest, Romania
| | - Adnan Al Aloul
- Department of Surgery, Ramnicu Sarat County Hospital, 125300 Buzau, Romania;
- Facullty of Medicine, “Titu Maiorescu” University of Medicine and Pharmacy, 031593 Bucharest, Romania
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Terasaki F, Kaneoka Y, Maeda A, Takayama Y, Fukami Y, Takahashi T, Uji M. The impact of standardized methods of hepatic vein reconstruction with an external iliac vein graft. Hepatobiliary Surg Nutr 2021; 10:163-171. [PMID: 33898557 DOI: 10.21037/hbsn.2019.09.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Liver tumors that invade the hepatic vein are surgically challenging, especially in patients with liver dysfunction. Preservation of as much of the parenchyma as possible is important; thus, when feasible, we perform hepatectomy with hepatic vein reconstruction (HVR) using an external iliac vein (EIV) graft. We conducted a retrospective study to investigate the benefit of HVR and to evaluate our procedure. Methods The study included patients treated by hepatectomy with HVR using EIV grafts and vascular clips. We reviewed the surgical outcomes, including total operation and HVR times, postoperative complications, and postoperative liver function. Results The surgeries included right HVR (n=13), left HVR (n=3), and middle HVR (n=1). The total operation time was 277±72 minutes (155-400 minutes), and the HVR time was 27±5 minutes (19-40 minutes). Graft patency was confirmed in 14 (82%) of the patients. One patient who underwent HVR with running sutures required emergency surgery due to graft thrombosis. Clavien-Dindo > grade IIIa postoperative complications occurred in 4 (23.5%) patients, but there were no treatment-related deaths. Conclusions In conclusion, our hepatic resections with HVR using the same techniques and graft materials showed acceptable surgical outcomes. From our experience, we believe that preparatory hepatic resection with HVR is an effective treatment, especially for patients with decreased liver function or with a small residual liver parenchyma.
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Affiliation(s)
| | - Yuji Kaneoka
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Atsuyuki Maeda
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yuichi Takayama
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasuyuki Fukami
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | | | - Masahito Uji
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan
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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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Combined Liver and Inferior Vena Cava Resection for Malignancies Is Safe and Feasible in a Group of High-Risk Patients. J Clin Med 2020; 9:jcm9041100. [PMID: 32290567 PMCID: PMC7231159 DOI: 10.3390/jcm9041100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/04/2020] [Accepted: 04/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background and Methods: Tumors infiltrating the inferior caval vein (ICV) have been considered irresectable in the past due to high perioperative risks. Consequently, the only treatment option for these patients was best supportive care, which resulted in reduced survival. Advancements in surgical techniques have since evolved, such that combined resections of the ICV and the hepatic malignancy are being performed. The aim of this study was the evaluation of the long-term outcomes (e.g., survival) and short-term risks of this procedure. In this single-center, retrospective cohort study (n = 24), we evaluated surgical and oncological outcome for patients undergoing hepatic surgery for oncological indications in combination with resections of the ICV. In addition, we investigated which factors are associated with survival. Results: First, we showed that perioperative mortality is as low as 4.1%. Second, we showed that perioperative co-morbidities are acceptable for this type of advanced hepatobiliary surgery. Third, the reconstruction of the ICV by means of a patch was superior in terms of survival compared to other types of reconstructions. This finding was independent of the type or the aggressiveness of tumor or the resections status. Discussion: In our cohort, many patients had undergone (multiple) preceding visceral surgical interventions or underwent multi-visceral surgery. Despite the medical complexity, survival was encouraging in this cohort, offering novel treatment modalities with a low risk of severe morbidities.
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Shi SJ, Wang DL, Hu W, Peng F, Kang Q. Ex vivo liver resection and autotransplantation with cardiopulmonary bypass for hepatoblastoma in children: A case report. Pediatr Transplant 2018; 22:e13268. [PMID: 30003622 DOI: 10.1111/petr.13268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 06/05/2018] [Indexed: 11/30/2022]
Abstract
Some primary and secondary liver carcinomas cannot be resected using a conventional approach due to their size, location, or major vascular invasion. The aim of this study was to explore the application of ex vivo liver resection and autotransplantation for complicated HB in children. A 1.5-year-old girl with HB after repeated chemotherapy was analyzed. In this patient, tumor invasion includes the IV, V, and VIII liver segments, and thrombosis formed in the inferior vena cava and right atrium. It is difficult to obtain complete tumor resection using conventional hepatectomy. The patient was treated via ex vivo liver resection and autotransplantation, and tumor thrombus in the inferior vena cava and right atrium was removed via cardiopulmonary bypass. Operative methods and precautions were analyzed during and after the operation. The operation was completed successfully within 8 hours, and the liver's cold ischemia time was 190 minutes. The patient recuperated successfully, and the liver's function and AFP levels gradually tended to normalize 2 weeks after the operation. Ultrasonic examination revealed that the blood flow velocity of the hepatic vein, portal vein, and hepatic artery was good. The patient recovered and was discharged 3 weeks after the operation. Ex vivo liver resection and autotransplantation have great application value for complicated HB in children that is not suitable for conventional hepatic lobectomy.
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Affiliation(s)
- Shu-Jun Shi
- Department of Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Deng-Liang Wang
- Department of Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Hu
- Department of Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Fei Peng
- Department of Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Quan Kang
- Department of Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China
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11
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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: 1.7] [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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12
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Tomimaru Y, Eguchi H, Wada H, Doki Y, Mori M, Nagano H. Liver resection combined with inferior vena cava resection and reconstruction using artificial vascular graft: A literature review. Ann Gastroenterol Surg 2018; 2:182-186. [PMID: 29863183 PMCID: PMC5980586 DOI: 10.1002/ags3.12068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/09/2018] [Indexed: 11/10/2022] Open
Abstract
In cases where liver tumors invade the inferior vena cava (IVC), IVC resection along with liver resection may be needed to effect a cure. Furthermore, if the IVC defect is large, IVC reconstruction with vascular graft after resection is required. There are limited reports of cases of IVC reconstruction using a graft. By reviewing data from the literature of previous studies, the present study was aimed at investigating the surgical outcomes of liver resection with IVC resection and reconstruction using an artificial vascular graft. PubMed was searched for previous articles reporting cases with the combined surgery. The search was limited to articles in English, and cases with exceptional surgeries such as in situ cold perfusion, and ante situm and ex vivo techniques were excluded from this study. Surgical outcomes of the extracted cases were investigated. Cases dealt only with primary closure after IVC resection, and those in which the IVC tumor thrombus was treated by opening the IVC wall, removing the thrombus and then closing the IVC without wall excision were not included in this study. The literature search identified 13 studies, including 111 cases. Operative mortality in the reported cases was 8.1% (9 out of 111 cases). Thrombus in the artificial vascular graft was observed in two cases, and patency of the graft during the follow-up period was confirmed in 109 of the 111 cases (98.2%). These results suggested that the surgical outcomes of liver resection combined with IVC resection and reconstruction using the artificial vascular graft were favorable.
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Affiliation(s)
- Yoshito Tomimaru
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuitaJapan
- Department of Gastroenterological SurgeryToyonaka Municipal HospitalToyonakaJapan
| | - Hidetoshi Eguchi
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Hiroshi Wada
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuitaJapan
- Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Yuichiro Doki
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Masaki Mori
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Hiroaki Nagano
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuitaJapan
- Department of Gastroenterological, Breast and Endocrine SurgeryYamaguchi University Graduate School of MedicineUbeJapan
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13
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Zhou Y, Wu L, Xu D, Wan T, Si X. A pooled analysis of combined liver and inferior vena cava resection for hepatic malignancy. HPB (Oxford) 2017. [PMID: 28645571 DOI: 10.1016/j.hpb.2017.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Limited data are currently available to address the safety and efficacy of combined resection of the liver and inferior vena cava (IVC) for hepatic malignancies. METHODS A systematic review was performed to identify relevant studies. Pooled individual data were examined for the clinical outcome of combined resection of the liver and IVC for hepatic malignancies. RESULTS A total of 258 patients were described in 38 articles eligible for inclusion. Resections were performed for colorectal liver metastasis (CLM) [n = 128 (50%)], intrahepatic cholangiocarcinoma (ICC) [n = 51 (20%)], hepatocellular carcinoma (HCC) [n = 48 (19%)], and other pathologies [n = 31 (11%)]. There were 14 (5%) perioperative deaths. The median survival duration was 34 months, and the 1-, 3- and 5-year overall survival (OS) rate was 79%, 46% and 33%, respectively. The 5-year OS rate was 26% for CLM, 37% for ICC, and 30% for HCC. CONCLUSION Combined resection of the liver and IVC for hepatic malignancies is safe and applicable, and offers acceptable survival outcomes.
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Affiliation(s)
- Yanming Zhou
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China.
| | - Lupeng Wu
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Dong Xu
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Tao Wan
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xiaoying Si
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
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14
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Li W, Wu H, Han J. Surgical outcomes of hepatocellular carcinoma invading hepatocaval confluence. Hepatobiliary Pancreat Dis Int 2016; 15:593-601. [PMID: 27919848 DOI: 10.1016/s1499-3872(16)60152-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Combined liver and inferior vena cava (IVC) resection followed by IVC and/or hepatic vein reconstruction (HVR) is a curative operation for selected patients with hepatocellular carcinoma (HCC) invading the hepatocaval confluence. The present study aimed to elucidate the prognostic factors for patients with HCC invading the hepatocaval confluence. METHODS Forty-two consecutive patients underwent hepatectomy, combined with IVC replacement and/or HVR for HCC between January 2009 and December 2014 were included in this study. The cases were divided into three groups based on the surgical approaches of HVR: group 1 (n=13), tumor invaded the hepatocaval confluence but with one or two hepatic veins intact in the residual liver, thus only the replacement of IVC, not HVR; group 2 (n=23), the hepatic vein of the residual liver was also partially invaded, and the hepatic vein defect was repaired with patches locally; group 3 (n=6), three hepatic veins at the hepatocaval confluence were infiltrated, and the hepatic vein remnant was re-implanted onto the side of the tube graft. The patient characteristics, intra- and postoperative results, and long-term overall survival were compared among the three groups. The survival-related factors were analyzed by univariate and multivariate analysis. RESULTS The group 1 had higher preoperative alpha-fetoprotein level (P<0.001), shorter operation time, hepatic ischemic time and hospital stay compared with groups 2 and 3 (P<0.05). The 1-, 3-, and 4-year overall survival rates of group 1 were 84.6%, 23.1% and 23.1%, respectively; group 2 were 78.3%, 8.7% and 8.7% respectively and group 3 were 83.3%, 0 and 0, respectively. The multivariate analysis showed that the independent poor prognostic factors of overall survival were preoperative higher HBV DNA level (≥103 copies/mL; P=0.001), tumor size (≥9 cm; P<0.0001), age (≥60 years; P=0.010) and underwent HVR (P<0.0001). CONCLUSIONS Patients with reconstructing hepatic vein with patches locally (group 2) or to the artificial graft (group 3) had worse long-term survival than those without HVR (group 1). HVR was one of the unfavorable prognostic factors of overall survival.
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Affiliation(s)
- Wei Li
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, China.
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15
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Ko S, Kirihataya Y, Matsumoto Y, Takagi T, Matsusaka M, Mukogawa T, Ishikawa H, Watanabe A. Retrocaval liver lifting maneuver and modifications of total hepatic vascular exclusion for liver tumor resection. World J Hepatol 2016; 8:411-420. [PMID: 27004089 PMCID: PMC4794531 DOI: 10.4254/wjh.v8.i8.411] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 01/13/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of technical modifications of total hepatic vascular exclusion (THVE) for hepatectomy involving inferior vena cava (IVC).
METHODS: Of 301 patients who underwent hepatectomy during the immediate previous 5-year period, 8 (2.7%) required THVE or modified methods of IVC cross-clamping for resection of liver tumors with massive involvement of the IVC. Seven of the patients had diagnosis of colorectal liver metastases and 1 had diagnosis of hepatocellular carcinoma. All tumors involved the IVC, and THVE was unavoidable for combined resection of the IVC in all 8 of the patients. Technical modifications of THVE were applied to minimize the extent and duration of vascular occlusion, thereby reducing the risk of damage.
RESULTS: Broad dissection of the space behind the IVC coupled with lifting up of the liver from the retrocaval space was effective for controlling bleeding around the IVC before and during THVE. The procedures facilitate modification of the positioning of the cranial IVC cross-clamp. Switching the cranial IVC cross-clamp from supra- to retrohepatic IVC or to the confluence of hepatic vein decreased duration of the THVE while restoring hepatic blood flow or systemic circulation via the IVC. Oblique cranial IVC cross-clamping avoided ischemia of the remnant hemi-liver. With these technical modifications, the mean duration of THVE was 13.4 ± 8.4 min, which was extremely shorter than that previously reported in the literature. Recovery of liver function was smooth and uneventful for all 8 patients. There was no case of mortality, re-operation, or severe complication (i.e., Clavien-Dindo grade of III or more).
CONCLUSION: The retrocaval liver lifting maneuver and modifications of cranial cross-clamping were useful for minimizing duration of THVE.
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16
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Seshadri RM, Baker EH, Templin M, Swan RZ, Martinie JB, Vrochides D, Iannitti DA. Outcomes of surgical resection and loco-regional therapy in patients with stage 3A hepatocellular carcinoma: a retrospective review from the national cancer database. HPB (Oxford) 2015; 17:964-8. [PMID: 26271743 PMCID: PMC4605333 DOI: 10.1111/hpb.12466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/02/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVES In advanced stages, hepatocellular carcinoma (HCC) is often associated with major vascular involvement (cava, portal vein). The aim of the present study was to analyse the role of surgical resection (SR) and loco-regional therapy (LRT) in these advanced stage patients to determine if there was a survival benefit. METHODS The study is a retrospective analysis from the Commission on Cancer's National Cancer Data Base (NCDB) from 1998 to 2011. In total, 148,882 patients with liver cancer were identified, of which 126,984 had HCC. Of these, 64,264 patients (1998-2006) had 5-year survival data available and 8825 patients had Stage 3A disease based on AJCC classification. Of these patients, 884 had SR, 771 had LRT and 7170 patients had neither intervention. Kaplan-Meier curves and log-rank tests were used for statistical analysis. RESULTS Eight thousand eight hundred and twenty-five patients met analysis criteria. The mean age (years) in the SR, LRT and no intervention group were 62.5, 64.3 and 64.2, respectively. Most patients were males in all three groups (77.5%, 74.5% and 68.1%). The mean tumour size (cm) in the three groups was 9.8, 6.4 and 8.4, respectively. SR and LRT were primarily performed in major academic and comprehensive cancer programmes compared with community cancer programmes and other centres (SR: 93% versus 7%; LRT: 94.6% versus 5.4%). The median 5-year survival (months) was 26.6 in SR, 16.5 in LRT and 4.8 in the no intervention group (P < 0.0001). CONCLUSION A SR and LRT offer a survival benefit in select patients diagnosed with Stage 3A HCC.
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Affiliation(s)
- Ramanathan M Seshadri
- Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - Erin H Baker
- Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - Megan Templin
- Dickson Advanced Analytics Group, Carolinas Medical CenterCharlotte, NC, USA
| | - Ryan Z Swan
- Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - John B Martinie
- Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - Dionisios Vrochides
- Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - David A Iannitti
- Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical CenterCharlotte, NC, USA
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17
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Repeat hepatectomy with inferior vena cava re-resection for colorectal liver metastases: case report and review of the literature. Surg Today 2014; 45:1450-6. [PMID: 25466296 DOI: 10.1007/s00595-014-1091-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 10/03/2014] [Indexed: 01/10/2023]
Abstract
Liver resection in patients with inferior vena cava (IVC) involvement is becoming more common with the adoption of vascular exclusion techniques and replacement of the IVC. Repeat hepatectomy and an aggressive surgical approach can offer satisfactory disease-free survival and a cure in selected patients. We herein describe a case of repeat hepatectomy with en bloc re-do IVC resection and reconstruction with Gore-Tex graft for recurrent colorectal liver disease. The patient had previously undergone non-anatomical right liver resection with IVC partial excision and reconstruction with a porcine pericardial patch. The patient is currently disease-free at 12 months' follow-up. Surgical treatment of liver tumors involving the IVC offers the only hope for prolonged survival. Re-do liver surgery with concomitant re-excision of the IVC is feasible and can be contemplated when macroscopic removal of the tumor is expected. Management of these complex cases by a specialist team with expertise in liver transplantation and vascular techniques is advised.
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18
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Dirican A, Özsoy M, Barut B, İnce V, Ateş M, Yılmaz S. Retrohepatic inferior vena cava reconstruction with saphenous vein patch in advanced stage cholangiocarcinoma. Turk J Surg 2014; 30:160-164. [PMID: 25931918 PMCID: PMC4379848 DOI: 10.5152/ucd.2014.2689] [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: 02/16/2014] [Accepted: 03/30/2014] [Indexed: 11/22/2022]
Abstract
Hepatic resection is the only known curative treatment option in primary and metastatic liver tumors. Unlike other types of malignancies, the response rate to even the best chemotherapy protocols is quite low in liver malignancies. Survival is expressed in months in untreated liver malignancies or in patients with residual tumor after resection. The optimal survival can be achieved only by liver resection with negative surgical margins. In order to increase the number of patients suitable for hepatic resection, techniques such as portal vein embolization, neoadjuvant chemotherapy, two-step hepatectomy, re-do hepatectomy, hypothermic liver perfusion have been developed and newer modalities are still being investigated. Primary liver malignancies like hepatocellular carcinoma and cholangiocarcinoma, and metastatic liver tumors can invade the retrohepatic vena cava due to anatomical proximity. Invasion of either the hepatocaval confluence or vena cava are often considered as contraindications for liver resection due to the risk of intraoperative massive air embolism or hemorrhage. In this article, we present a patient who underwent left hepatectomy together with vena cava resection and reconstruction with saphenous vein patch due to cholangiocarcinoma.
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Affiliation(s)
- Abuzer Dirican
- Department of Hepatopancreaticobiliary Surgery and Liver Transplantation, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Mustafa Özsoy
- Department of General Surgery, Afyon Kocatepe University Faculty of Medicine, Afyon, Turkey
| | - Bora Barut
- Department of Hepatopancreaticobiliary Surgery and Liver Transplantation, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Volkan İnce
- Department of Hepatopancreaticobiliary Surgery and Liver Transplantation, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Mustafa Ateş
- Department of Hepatopancreaticobiliary Surgery and Liver Transplantation, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Sezai Yılmaz
- Department of Hepatopancreaticobiliary Surgery and Liver Transplantation, İnönü University Faculty of Medicine, Malatya, Turkey
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19
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Azoulay D, Pascal G, Salloum C, Adam R, Castaing D, Tranecol N. Vascular reconstruction combined with liver resection for malignant tumours. Br J Surg 2014; 100:1764-75. [PMID: 24227362 DOI: 10.1002/bjs.9295] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND The resectability criteria for malignant liver tumours have expanded during the past two decades. The use of vascular reconstruction after hepatectomy has been integral in this process. However, the majority of reports are anecdotal. This is a retrospective analysis of the techniques, morbidity, mortality and risk factors of liver resections with vascular reconstruction based on a large series from a single centre. METHODS Patients who underwent hepatic resection combined with vascular resection and reconstruction between 1997 and 2009 were included in this study. Indications for surgery, morbidity and 90-day mortality are reported along with factors predictive of operative mortality. RESULTS Eighty-four patients had liver resection with 97 vascular resections and reconstruction. There were 44 men and 40 women with a mean(s.d.) age of 56·9(12·1) years. Mean(s.d.) follow-up was 37·3(34·1) months. All patients had primary or metastatic liver tumours. The perioperative morbidity rate was 62 per cent (52 patients) and the operative mortality rate 14 per cent (12). Predictors of operative mortality were: bilirubin level exceeding 34 µmol/ml (P = 0·023), indocyanine green retention rate at 15 min over 10 per cent (P = 0·031), duration of ischaemia (P = 0·011), amount of blood transfused (P = 0·025) and combined major extrahepatic procedure (P = 0·042). Actuarial 3- and 5-year survival rates were 44 and 26 per cent respectively. CONCLUSION Liver resection with combined vascular resection and reconstruction can be performed in selected patients with acceptable morbidity and mortality. The lack of therapeutic alternatives and the poor outcome of non-operative management seem to justify this approach. The identification of risk factors should help improve patient selection and postoperative outcome as well as facilitate objective risk communication with surgical candidates.
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Affiliation(s)
- D Azoulay
- Centre Hépato-Biliaire, Département de Chirurgie Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Paul Brousse, Villejuif; Service de Chirurgie Hépato-Bilio-Pancreatique, AP-HP Hôpital Henri Mondor, Créteil, France
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20
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Stättner S, Yip V, Jones RP, Lacasia C, Fenwick SW, Poston GJ, Malik H. Liver resection with concomitant inferior vena cava resection: experiences without veno-venous bypass. Surg Today 2013; 44:1063-71. [DOI: 10.1007/s00595-013-0652-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/13/2013] [Indexed: 12/13/2022]
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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: 66] [Impact Index Per Article: 5.5] [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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22
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Padilla-Fernandez B, Lorenzo-Gomez MF, Herrero-Polo M, Silva-Abuin JM, Martin-Izquierdo M, Antunez-Plaza P. Leiomyosarcoma of the inferior vena cava in a patient with double inferior vena cava. Ann Vasc Surg 2012; 26:859.e1-5. [PMID: 22717359 DOI: 10.1016/j.avsg.2011.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 07/03/2011] [Accepted: 11/04/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor arising from its smooth muscle cells. METHODS AND RESULTS We report the case of a 38-year-old woman presenting with back pain and weight loss who was diagnosed with a 22-cm leiomyosarcoma of the right IVC and thrombosis of the left IVC. The patient is alive and free of recurrence a year after radical tumor resection with removal of the affected IVC, reconstruction with polytetrafluoroethylene prosthetic graft, and anastomosis of both right and left IVC. CONCLUSIONS Leiomyosarcoma is a rare and aggressive tumor with a deceitful course. Radical surgical en bloc resection is the mainstay of treatment for IVC leiomyosarcomas. For an adequate restoration of venous return, complex vascular repair may be necessary.
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23
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Malde DJ, Khan A, Prasad KR, Toogood GJ, Lodge JPA. Inferior vena cava resection with hepatectomy: challenging but justified. HPB (Oxford) 2011; 13:802-10. [PMID: 21999594 PMCID: PMC3238015 DOI: 10.1111/j.1477-2574.2011.00364.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 06/19/2011] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical outcome of hepatectomy combined with inferior vena cava (IVC) resection and reconstruction for treatment of invasive liver tumours. METHODS From February 1995 to September 2010, 2146 patients underwent liver resections in our hospital's hepatopancreatobiliary unit. Of these, 35 (1.6%) patients underwent hepatectomy with IVC resection. These patients were included in this study. Data were analysed from a prospectively collected database. RESULTS Resections were carried out for colorectal liver metastasis (CRLM) (n= 21), hepatocellular carcinoma (n= 6), cholangiocarcinoma (n= 3) and other conditions (n= 5). Resections were carried out with total vascular occlusion in 34 patients and without in one patient. In situ hypothermic perfusion was performed in 13 patients; the ante situm technique was used in three patients, and ex vivo resection was used in six patients. There were four early deaths from multiple organ failure. Postoperative complications occurred in 14 patients, three of whom required re-operation. Median overall survival was 29 months and cumulative 5-year survival was 37.7%. Rates of 1-, 2- and 5-year survival were 75.9%, 58.7% and 19.6%, respectively, in CRLM patients. CONCLUSIONS Aggressive surgical management of liver tumours with IVC involvement offers the only hope for cure in selected patients. Resection by specialist teams affords acceptable perioperative morbidity and mortality rates.
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Affiliation(s)
- Deep J Malde
- Hepatopancreatobiliary and Transplant Unit, St James University Hospital, Leeds, UK
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24
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Nuzzo G, Giordano M, Giuliante F, Lopez-Ben S, Albiol M, Figueras J. Complex liver resection for hepatic tumours involving the inferior vena cava. Eur J Surg Oncol 2011; 37:921-7. [PMID: 21924855 DOI: 10.1016/j.ejso.2011.08.132] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 08/23/2011] [Accepted: 08/28/2011] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Resection of liver tumours with involvement of inferior vena cava (IVC) is considered to have a high surgical risk. AIM We retrospectively reviewed 23 patients who underwent hepatectomy with IVC resection in two West-European liver surgery Units. METHODS The tumours included liver metastases (n = 13), hepatocellular carcinoma (n = 4), intrahepatic cholangiocarcinoma (n = 3), liver haemangioma (n = 1), primary hepatic lymphoma (n = 1) and recurrent right adrenal gland carcinoma (n = 1). RESULTS IVC resection was associated with right hepatectomy in 8 cases, extended right hepatectomy in 9 cases, extended left hepatectomy in 3 cases, minor liver resection in 2 cases, and right hepatectomy with nephrectomy in one case. In 16 patients the IVC wall involvement was <30% of its circumference, and a tangential vena cava resection was performed. In 7 patients (30%) with >50% involvement, a caval segment was resected and replaced with a 20 mm ringed polytetrafluoroethylene graft. R0-resection was achieved in all patients. Median intraoperative blood loss was 1.100 ml (range 490-15,000). Fourteen patients were transfused with a median of 3 PRC units per patient (range 1-25). Major complications occurred in 9 patients. Postoperative stay in ICU was 2.3 ± 3.4 days (range 1-14) and hospital stay was 17.3 ± 2.6 days (range 5-62). In 14 patients, final pathology demonstrated microscopic IVC infiltration. CONCLUSIONS In selected patients with malignant involvement of the liver and IVC, surgical resection en bloc with IVC is the only possibility to achieve R0 resection, with acceptable mortality and morbidity, in units specialized in liver surgery.
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Affiliation(s)
- G Nuzzo
- Hepato-Biliary Surgery Unit, Department of Surgical Sciences, Catholic University of Sacred Heart, Rome, Italy
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Garcea G, Ong SL, Maddern GJ. Inoperable colorectal liver metastases: a declining entity? Eur J Cancer 2008; 44:2555-72. [PMID: 18755585 DOI: 10.1016/j.ejca.2008.07.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 07/14/2008] [Accepted: 07/17/2008] [Indexed: 12/19/2022]
Abstract
BACKGROUND Untreated colorectal liver metastases (CLMs) have a dismal prognosis. Surgery remains the gold standard of treatment, but many patients will have inoperable disease at presentation. Until recently, the outlook for such patients was bleak. The purpose of this review was to report on available options in the treatment CLMs, which would be considered unresectable by conventional evaluation. METHODS Inclusion criteria were articles published in English-language journals reporting on either retrospective or prospective cohorts of patients undergoing treatment for conventionally inoperable CLM. Main outcome measures were survival, resectability rates, morbidity and mortality following treatment of the patients' disease. RESULTS Improved chemotherapy regimes and other innovative treatments have opened up new options for such patients and may even render conventionally inoperable disease resectable. The aim of treatment should be down-staging of metastases to achieve resectability, however, other treatments such as ablation may be also be used (either alone or in conjunction with resection). CONCLUSION A nihilistic attitude to the patient with seemingly inoperable liver metastases should be discouraged. Discussion of such patients at multi-disciplinary meetings is essential in order to plan and monitor treatments.
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Affiliation(s)
- G Garcea
- Department of Hepatobiliary and Upper Gastrointestinal Surgery, The Queen Elizabeth Hospital, Adelaide, SA, Australia.
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Nimura Y. Radical surgery: vascular and pancreatic resection for cholangiocarcinoma. HPB (Oxford) 2008; 10:183-5. [PMID: 18773051 PMCID: PMC2504372 DOI: 10.1080/13651820801992682] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Indexed: 12/12/2022]
Abstract
Recent progress in vascular surgical techniques has made it possible to combine liver and portal vein and/or hepatic artery (HA) or retrohepatic inferior vena cava (IVC) resection and reconstruction in cases of locally advanced cholangiocarcinoma. Reports of the success of this difficult surgery have been published. Aggressive Japanese surgeons have applied hepatopancreatoduodenectomy (HPD) not just in cases of advanced gallbladder cancer, but also in locally advanced cholangiocarcinoma with or without superficial spread. The above extended surgeries were associated with high postoperative morbidity and mortality, but recent progress in perioperative management and surgical techniques has improved the outcome of these types of surgery. Combined portal vein and liver resection provides R0 resection and contributes to longer survival in resected patients with locally advanced cholangiocarcinoma than in unresected patients. Portal vein invasion is a strong prognostic factor of cholangiocarcinoma and the actual number of 5-year survivors is limited. The number of clinical cases of liver resection combined with IVC or HA resection and reconstruction is still limited, and therefore the long-term survival benefit from these procedures has not been clarified. HPD carried high morbidity and mortality rates in the 1990s, but the outcome has been improving and an increasing number of 5-year survivors has been reported. Although the clinical value of the above extended surgeries has not been evaluated prospectively, with the increasing number of retrospective studies it has been concluded that combined liver and portal vein and/or HA or IVC resection or HPD could be indicated for selected patients with locally advanced cholangiocarcinoma.
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Hashimoto T, Minagawa M, Aoki T, Hasegawa K, Sano K, Imamura H, Sugawara Y, Makuuchi M, Kokudo N. Caval invasion by liver tumor is limited. J Am Coll Surg 2008; 207:383-92. [PMID: 18722944 DOI: 10.1016/j.jamcollsurg.2008.02.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Accepted: 02/19/2008] [Indexed: 12/22/2022]
Abstract
BACKGROUND Successful hepatic resection with combined inferior vena cava (IVC) resection has been reported. The necessity of a combined IVC resection for hepatic malignancies that have attached to the IVC has not been fully evaluated. STUDY DESIGN In this retrospective study, 162 lesions for which preoperative CT findings suggested attachment to the IVC were evaluated. Patient survival rates were examined according to type of tumor and the operative procedure. For adenocarcinoma lesions, several CT findings, including extent of the IVC circumference attached to the tumor compared with the whole IVC circumference (E(IVC)), were evaluated in conjunction with IVC resection. RESULTS Among 162 lesions, 18 adenocarcinoma lesions were resected in combination with an IVC resection. Histologic IVC invasion was confirmed in eight patients. None of the 67 hepatocellular carcinoma lesions required concomitant IVC resection. Overall 5-year survival rate of the patients who underwent concomitant liver and IVC resections was 33.1%. Among the adenocarcinoma lesions, the positive predictive factors for IVC resection were an E(IVC) value > 25% and a peaked deformity of the IVC wall, according to a multivariate analysis. CONCLUSIONS Most hepatic malignancies attached to the IVC wall can be completely removed without IVC resection. E(IVC) and deformity of the IVC on CT can be useful indicators for a concomitant liver and IVC resection. Careful separation of the liver and IVC is a key point for minimizing the size of the resected IVC and to avoid unnecessary IVC resection.
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Affiliation(s)
- Takuya Hashimoto
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Tranchart H, Carloni A, Balzarotti R, de Laveaucoupet J, Chapelier A, Smadja C. Leiomyosarcoma of the inferior vena cava involving the renal veins: a simple method of right renal vein reimplantation. J Vasc Surg 2008; 47:209-12. [PMID: 18178476 DOI: 10.1016/j.jvs.2007.06.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Revised: 06/22/2007] [Accepted: 06/22/2007] [Indexed: 11/20/2022]
Abstract
In this report we describe a case of leiomyosarcoma of the inferior vena cava involving the renal veins. The abdominal computed tomography scan showed a tumor in the infrahepatic portion of the inferior vena cava and the confluence of the renal veins. After resection of the tumor, venous reconstruction involved the replacement of the inferior vena cava with a prosthetic graft and the implantation of the right renal vein into the portal vein. The left renal vein was ligated distally, with preservation of collateral pathways. To our knowledge, no other reports of such venous reconstruction have been published. After a follow-up of 30 months, the patient has shown no further symptoms, and the abdominal computed tomography scan demonstrates patency of the renal portal anastomosis. Tests indicated normal renal and hepatic function, suggesting good tolerance of the renal portal anastomosis. We believe that the technique described in this report should be adopted routinely for tumors located in the renal veins, provided complete resection of the tumor with a comfortable resection margin is possible.
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Affiliation(s)
- Hadrien Tranchart
- Department of Visceral Surgery, Hôpital Antoine Béclère, AP-HOP de Paris, 157 rue de la Porte de Trivaux, Clamart, France
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Bringing unresectable liver disease to resection with curative intent. Eur J Surg Oncol 2007; 33 Suppl 2:S42-51. [DOI: 10.1016/j.ejso.2007.09.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Accepted: 09/26/2007] [Indexed: 12/31/2022] Open
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Delis SG, Madariaga J, Ciancio G. Combined liver and inferior vena cava resection for hepatic malignancy. J Surg Oncol 2007; 96:258-64. [PMID: 17443739 DOI: 10.1002/jso.20794] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The experience from a single center, in combined liver and inferior vena cava (IVC) resection for liver tumors, is presented. METHODS Twelve patients underwent a combined liver resection with IVC replacement. The median age was 45 years (range 35-67 years). Resections were carried out for hepatocellular carcinoma (n = 4), colorectal metastases (n = 6), and cholangiocarcinoma (n = 2). Liver resections included eight right lobectomies and four left trisegmentectomies. The IVC was reconstructed with ringed Gore-Tex tube graft. RESULTS No perioperative deaths were reported. The median operative blood transfusion requirement was 2 units (range 0-12 units) and the median operative time was 5 hr. Median hospital stay was 10 days (range 8-25 days). Three patients had evidence of postoperative liver failure, resolved with supportive management. Two patients developed bile leaks, resolved conservatively. With a median follow up of 24 months, all vascular reconstructions were patent and no evidence of graft infection was documented. CONCLUSIONS Aggressive surgical management of liver tumors, offer the only hope for cure or palliation. We suggest that liver resection with vena cava replacement may be performed safely, with acceptable morbidity, by specialized surgical teams.
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Affiliation(s)
- Spiros G Delis
- Department of Surgery, Division of Transplantation, University of Miami School of Medicine, Miami, Florida 33101, USA.
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31
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Delis S, Triantopoulou C, Bakoyiannis A, Tassopoulos N, Dervenis C. Leiomyosarcoma of the infrarenal portion of the inferior vena cava in a cirrhotic patient with hepatitis C. ACTA ACUST UNITED AC 2007; 33:222-4. [PMID: 17387534 DOI: 10.1007/s00261-007-9217-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Leiomyosarcoma of the inferior vena cava is a rare primary tumor. We present a case of a 65-year-old man with the history of cirrhosis and non-specific symptoms. The patient underwent computed tomography and magnetic resonance imaging that revealed a leiomyosarcoma of the infrarenal portion of inferior vena cava. Clinical and imaging features, as well as the surgical technique of resection are discussed.
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Affiliation(s)
- Spiros Delis
- Liver Surgery Unit, First Surgery Department, Agia Olga Hospital, Athens, Greece
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32
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Azoulay D, Andreani P, Maggi U, Salloum C, Perdigao F, Sebagh M, Lemoine A, Adam R, Castaing D. Combined liver resection and reconstruction of the supra-renal vena cava: the Paul Brousse experience. Ann Surg 2006; 244:80-8. [PMID: 16794392 PMCID: PMC1570596 DOI: 10.1097/01.sla.0000218092.83675.bc] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Liver tumors with inferior vena cava (IVC) involvement may require combined resection of the liver and IVC. This approach, with its high surgical risks and poor long-term prognosis, was precluded until the development of neoadjuvant chemotherapy, portal vein embolization, reinforced vascular prostheses, and technical advances in liver transplantation. METHODS We reviewed 22 cases of hepatectomy with retrohepatic IVC resection and reconstruction. The patients had a median age of 51.5 years (range, 32.8-75.3 years). Indications for resection were: liver metastases (n = 9), cholangiocarcinoma (n = 8), hepatocellular carcinoma (n = 2), other cancers (n = 3). The liver resections carried out included 18 first, 3 second, and one third hepatectomy. Segment 1 (caudate lobe) was included in the specimen in 19 cases (86%). Resection concerned 1 to 6 liver segments (median = 5.0). Vascular control was achieved by vascular exclusion of the liver preserving the caval flow (n = 1), standard vascular exclusion of the liver (n = 12), in situ cold perfusion of the liver (n = 9). Ex situ surgery was not necessary in any case. Venovenous bypass was used in 12 cases. The IVC was reconstructed with a ringed Gore-Tex tube graft (n = 10), primarily (n = 8), or by caval plasty (n = 4). A main hepatic vein was reimplanted in 6 cases: into the native IVC (n = 4) or into a Gore-Tex tube graft (n = 2). RESULTS One patient died (4.5%) due to catheter infection, 7 days after in situ cold perfusion with replacement of the vena cava. Eight patients (36%) had no complications and 14 patients (64%) had 23 complications. In all but 1 case, the complications were transient and successfully controlled. The patients stayed in intensive care for 3.3 +/- 2.0 days and in the hospital for 17.7 +/- 7.8 days. All vascular reconstructions were patent at last follow-up. With median follow-up of 19 months, 10 patients died of tumor recurrence and eleven were alive with (n = 5) or without (n = 6) disease. Actuarial 1-, 3-, and 5-year survival rates were 81.8%, 38.3%, and 38.3%, respectively. CONCLUSIONS IVC resection and reconstruction combined with liver resection can be safely performed in selected patients. The lack of alternative treatments and the spontaneous poor prognosis justify this approach, provided that surgery is carried out at a center specialized in both liver surgery and liver transplantation. The development of adjuvant chemotherapy regimens is required to improve the long-term results of this salvage surgery.
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Affiliation(s)
- Daniel Azoulay
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France.
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Ruh J, Lang H, Paul A, Dirsch O, Broelsch CE. Surgical Aspects in the Therapy of Primary Sarcoma of the Vena Cava. J Am Coll Surg 2006; 202:559-62. [PMID: 16500264 DOI: 10.1016/j.jamcollsurg.2005.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 10/28/2005] [Accepted: 11/09/2005] [Indexed: 11/15/2022]
Affiliation(s)
- Joachim Ruh
- Department of General and Transplantation Surgery, University of Essen, Essen, Germany
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Manzanet G, Morón R, Suelves C, Calderón R, Corell R, Castell L, Trías A, Todolí G, Navarro J, Peiró E, Clarós A. [Prosthetic replacement of the inferior vena cava. Current controversies]. Cir Esp 2006; 77:170-2. [PMID: 16420911 DOI: 10.1016/s0009-739x(05)70831-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A ringed polytetrafluoroethylene (PTFE) graft is currently the most widely used replacement for the inferior vena cava, although clinical studies comparing this technique with non-ringed prostheses are lacking. There is no consensus on the need to use an anticoagulant or associate a temporary distal arteriovenous fistula to increase venous flow. At present, the best therapeutic strategy cannot be determined. We present a case of retroperitoneal sarcoma infiltrating the infrarenal vena cava, right colon and ureter that was surgically treated in our hospital. En bloc resection was performed and the vena cava was reconstructed using a non-ringed PTFE graft associated with systemic anticoagulation.
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Affiliation(s)
- Gerardo Manzanet
- Servicio de Cirugía General, Hospital de La Plana, Vila-Real, Castellón, España.
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Nardo B, Ercolani G, Montalti R, Bertelli R, Gardini A, Beltempo P, Puviani L, Pacilè V, Vivarelli M, Cavallari A. Hepatic resection for primary or secondary malignancies with involvement of the inferior vena cava: is this operation safe or hazardous? J Am Coll Surg 2005; 201:671-679. [PMID: 16256908 DOI: 10.1016/j.jamcollsurg.2005.06.272] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Revised: 06/23/2005] [Accepted: 06/29/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study evaluated surgical techniques and results of patients with tumors who had undergone liver resection with partial resection and reconstruction of the IVC. STUDY DESIGN We performed a retrospective analysis of all patients who underwent combined liver and IVC resection and reconstruction at a single institution. We identified 19 patients and two categories of tumors, primary (n = 8) and metastatic (n = 11). In 12 patients, a direct suture of the IVC was performed; in 3 patients a pericardium bovine patch was applied; in another 4 patients the IVC was replaced by PTFEt prosthesis. In nine patients, total hepatic vascular occlusion was required. RESULTS Perioperative mortality was 5.9%, related to technical complications and hepatic insufficiency. Postoperative morbidity was 57.9%. Median survival time was 32 months (range 3 to 125 months). The 1-, 2-, and 5-year cumulative survival rates were 78.9%, 68%, and 49.1%, respectively. Tumor recurrence appeared in 13 patients and was the main cause of death (55.5%). Among the seven patients suffering from hepatocellular carcinoma, three are still alive at 31, 60, and 125 months after resection. In this group, 1-, 2-, and 5-year survival rates were 71.4%, 57.1%, and 38.1%. Among the 11 patients resected for colorectal liver metastases, the 1-, 2-, and 5-year survival rates were 81.8%, 62.3%, and 51.9%, respectively. CONCLUSIONS Liver resection combined with IVC resection and reconstruction is a feasible procedure that can be performed with an acceptable operative risk leading to longterm outcome in selected patients.
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Affiliation(s)
- Bruno Nardo
- General Surgery Unit, Department of Surgery, Intensive Care Unit and Transplantations, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Hardwigsen J, Balandraud P, Ananian P, Saïsse J, Le Treut YP. Leiomyosarcoma of the retrohepatic portion of the inferior vena cava: clinical presentation and surgical management in five patients. J Am Coll Surg 2005; 200:57-63. [PMID: 15631921 DOI: 10.1016/j.jamcollsurg.2004.09.035] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Revised: 09/02/2004] [Accepted: 09/02/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND Leiomyosarcoma (LMS) is a rare primary soft tissue sarcoma arising from the inferior vena cava (IVC). For LMS involving the retrohepatic portion of IVC there are limited published data about tumor features, surgical strategies, and IVC replacement. STUDY DESIGN Clinical data, surgical procedures, and pathologic features of five consecutive patients referred for IVC-LMS, in 5 years, were reviewed. A complete surgical resection of the tumor was performed in each patient and IVC replacement used expanded polytetrafluoroethylene grafts. RESULTS Abdominal pain (n = 4) and palpable flank mass (n = 3) were the most frequent signs. To assure a complete tumoral exeresis, adjacent organ resection included hepatectomy (n = 4), extended right nephrectomy (n = 3), and right adrenalectomy (n = 1). Prosthetic IVC reconstruction was performed in four patients, three times associated with arteriovenous fistula. Median postoperative stay was 18 days. No prosthetic-related complication was observed, venous insufficiency sequela did not occur. Tumoral clearance was achieved in all patients, and direct tumoral involvement of the liver was less frequent than for kidney. Three patients died at a median followup of 34 months, two are alive and disease-free at 34 and 44 months. CONCLUSIONS LMS of the IVC is characterized by locally advanced status at the time of diagnosis. A radical tumoral resection associated with liberal use of venous prosthetic replacement may offer a chance for cure and good quality of life in palliative situations.
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Affiliation(s)
- Jean Hardwigsen
- Department of Surgery and Liver Transplantation, Hôpital de la Conception, 147 Boulevard Baille, 13385 Marseilles Cedex 5, France
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Hashimoto T, Kokudo N, Aoki T, Natori T, Arita J, Sano K, Imamura H, Sugawara Y, Makuuchi M. Reconstruction of middle hepatic vein using a rotating left hepatic vein flap. J Am Coll Surg 2004; 199:656-60. [PMID: 15454155 DOI: 10.1016/j.jamcollsurg.2004.04.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2004] [Accepted: 04/29/2004] [Indexed: 12/01/2022]
Affiliation(s)
- Takuya Hashimoto
- Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, University of Tokyo, Tokyo, Japan
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Hemming AW, Reed AI, Langham MR, Fujita S, Howard RJ. Combined resection of the liver and inferior vena cava for hepatic malignancy. Ann Surg 2004; 239:712-9; discussion 719-21. [PMID: 15082976 PMCID: PMC1356280 DOI: 10.1097/01.sla.0000124387.87757.eb] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The objective of this paper is to review the results of combined resection of the liver and inferior vena cava for hepatic malignancy. The morbidity and mortality along with preliminary survival data are assessed in order to determine the utility of this aggressive approach to otherwise unresectable tumors. SUMMARY BACKGROUND DATA Involvement of the inferior vena cava has traditionally been considered a contraindication to resection for advanced tumors of the liver because the surgical risks are high and the long-term prognosis is poor. Progress in liver surgery allows resection in some cases. METHODS Twenty-two patients undergoing hepatic resection from 1997 to 2003, that also required resection and reconstruction of the inferior vena cava (IVC), were reviewed. The median age was 49 years (range 2 to 68 years). Resections were carried out for: hepatocellular carcinoma (n = 6), colorectal metastases (n = 6), cholangiocarcinoma (n = 5), gastrointestinal stromal tumor (n = 2), hepatoblastoma (n = 2), and squamous cell carcinoma in 1 patient. Liver resections performed included 13 right trisegmentectomies, 6 right lobectomies extended to include the caudate lobe, and 3 left trisegmentectomies. Complex ex vivo procedures were performed in 2 cases using venovenous bypass while the other 20 cases were performed using varying degrees of vascular isolation. In situ cold perfusion of the liver was used in 1 case. The IVC was reconstructed with ringed Gore-Tex tube graft (n = 14), primarily (n = 6), or with Gore-Tex patches (n = 2). RESULTS There were 2 perioperative deaths (9%). One cirrhotic patient died of liver failure 3 weeks post operatively and 1 patient with cholangiocarcinoma died of pulmonary hemorrhage secondary to a cavitating pulmonary infection after aspiration pneumonia 6 weeks after resection. Six patients had evidence of postoperative liver failure that resolved with supportive management and 2 patients required temporary dialysis. All vascular reconstructions were patent at last follow-up. With median follow-up of 26 months, 5 patients have died of recurrent malignancy at 44, 40, 32, 26, and 24 months, while an additional patient is alive with disease at 31 months. Actuarial 1-, 3-, and 5-year survivals were 85%, 60%, and 33%, respectively. CONCLUSIONS IVC involvement by hepatic malignancy does not necessarily preclude resection. Liver resection with reconstruction of the inferior vena cava can be performed in selected cases. The increased risk associated with the procedure appears to be balanced by the possible benefits, particularly when the lack of alternative curative approaches is considered.
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Affiliation(s)
- Alan W Hemming
- Department of Surgery, Center for Hepatobiliary Diseases, PO Box 100286, University of Florida, Gainesville, FL 32610-0286, USA.
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Aoki T, Sugawara Y, Imamura H, Seyama Y, Minagawa M, Hasegawa K, Kokudo N, Makuuchi M. Hepatic resection with reconstruction of the inferior vena cava or hepatic venous confluence for metastatic liver tumor from colorectal cancer. J Am Coll Surg 2004; 198:366-72. [PMID: 14992737 DOI: 10.1016/j.jamcollsurg.2003.11.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2003] [Revised: 11/03/2003] [Accepted: 11/04/2003] [Indexed: 12/12/2022]
Abstract
BACKGROUND Resection of colorectal liver metastases infiltrating the inferior vena cava (IVC) or hepatic venous confluence (HVC) is technically feasible, but the procedure frequently involves invasive techniques, and its long-term outcome has not yet been fully described. STUDY DESIGN From October 1994 through June 2001, 87 patients underwent first curative hepatic resections for colorectal metastases. Nine patients (the IVC/HVC group) received hepatectomy combined with IVC or HVC reconstruction. Clinicopathologic characteristics, surgical results, and patient survival were investigated and compared with those of the remaining 78 patients (the comparison group). RESULTS Three IVCs and eight hepatic veins were successfully resected and reconstructed by primary closure (n = 3), direct anastomosis (n = 1), or by the use of autologous vein grafts (n = 7). A comparison between the two groups revealed that the primary colorectal tumor stage was similar, but the IVC/HVC group had more (median 4 versus 2, p < 0.05) and larger (median 5.0 versus 3.2 cm, p < 0.05) lesions. The IVC/HVC group required longer operating times (median 600 versus 320 minutes, p < 0.001) and suffered greater blood loss (median 1,034 versus 434 g, p < 0.01) and more extensive liver parenchyma resection (median 585 versus 155 g, p < 0.001). Patients in the IVC/HVC group had a shorter survival time (median survival time 25.8 versus 44.0 months, p < 0.01). CONCLUSIONS Hepatic resection combined with the IVC or HVC reconstruction for colorectal liver metastases can be performed with acceptable morbidity, and possibly with no mortality. Although no definite conclusion on long-term survival can be drawn from our study, given the limited number of patients, their overall survival was unsatisfactory. Further studies are needed to clarify the contribution of combined resection and reconstruction of IVC/HVC to long-term survival, because surgical resection currently provides the only hope of cure.
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Affiliation(s)
- Taku Aoki
- Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Yin ZY, Wang XM, Yu RX, Zhang BM, Yu KK, Li N, Li JS. Total vascular exclusion technique for resection of hepatocellular carcinoma. World J Gastroenterol 2003; 9:2194-7. [PMID: 14562376 PMCID: PMC4656461 DOI: 10.3748/wjg.v9.i10.2194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To improve the low resection rate, poor prognosis and to control the massive hemorrhage during operation, total vascular exclusion (TVE) technique was used in hepatectomies of advanced and complicated hepatocellular carcinomas (HCCs).
METHODS: Five hundred and thirty patients with HCCs were admitted in our hospital. They were divided into TVE technique group (group A: n = 78), Pringle maneuver method group (group B: n = 176) and unresectable group (group C: n = 276). The clinical, operative, pathological parameters and outcome of the patients were statistically evaluated.
RESULTS: Group A had a significantly higher resection rate than group B (accounting for 47.92% and 33.21% respectively). There was no significant difference in blood loss, blood transfusion and perioperative mortality between groups A and B. Both groups had the similar median disease free survival time (14.6 vs 16.3 months) and 1 year survival rate (92.9% vs 95.5%). The TVE group had a medial survival time of 40.5 months and its 5-year survival rate was 34.6%.
CONCLUSION: As compared with Pringle maneuver method, the total vascular exclusion is a safe and effective technique to increase the total resection rate of advanced and complicated HCCs.
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Affiliation(s)
- Zhen-Yu Yin
- Institute of General Surgery, School of Medicine, Nanjing University, Jiangsu Province, China.
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Hemming AW, Reed AI, Langham MR, Fujita S, van der Werf WJ, Howard RJ. Hepatic vein reconstruction for resection of hepatic tumors. Ann Surg 2002; 235:850-8. [PMID: 12035042 PMCID: PMC1422515 DOI: 10.1097/00000658-200206000-00013] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
SUMMARY BACKGROUND DATA Involvement of the hepatic veins requiring reconstruction has traditionally been considered a contraindication to resection for advanced tumors of the liver because the surgical risks are high and the long-term prognosis poor. Recent advances in liver surgery gleaned from split and live donor liver transplantation that necessitate hepatic vein reconstruction can be applied to hepatic resection in some cases. METHODS Sixteen patients who underwent hepatic resection requiring hepatic vein reconstruction from 1996-2001 were reviewed. The mean age was 43 years (range 2-61). Nine patients were resected for hepatocellular carcinoma (HCC), five patients for colorectal metastases, and one patient each for hepatoblastoma and cholangiocarcinoma. In six patients with HCC and cirrhosis, the right hepatic vein was reconstructed to provide venous outflow to liver segments not adequately drained by a remaining major hepatic vein. Four of these six patients required the use of Gore-Tex (W. L. Gore & Associates, Inc., Newark, DE) interposition grafts. In the 10 other cases the entire venous outflow from the remnant liver was reconstructed or reimplanted into the inferior vena cava primarily (n = 8) or using segments of the portal vein from the resected side of the liver as a graft (n = 2). Ex-vivo procedures with the use of veno-venous bypass were required in two cases and in-situ cold perfusion of the liver was used in one case. RESULTS There were two perioperative deaths (12%). One patient died of liver failure 3 weeks after right trisegmentectomy with reconstruction of the left hepatic vein and one patient died at 3 months after resection due to sepsis from a segment of small bowel that perforated into a diaphragmatic hernia. Four patients had evidence of postoperative liver failure that resolved with supportive management and one patient required temporary dialysis. All vascular reconstructions were patent at last followup. With median followup of 23 months, 3 patients have died of recurrent malignancy at 14, 18 and 30 months, while an additional patient went on to die of progressive liver failure at 22 months. Actuarial 1 and 3 year survival was 88% and 50% respectively. CONCLUSION Hepatic vein involvement by hepatic malignancy does not necessarily preclude resection. Liver resection with reconstruction of the hepatic veins can be performed in selected cases. The increased risk associated with the procedure appears to be balanced by the possible benefits, particularly when the lack of alternative curative approaches is considered.
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Affiliation(s)
- Alan W Hemming
- Department of Surgery, Center for Hepatobiliary Disease, University of Florida, Gainesville 32610, USA.
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Sener SF, Winchester DJ, Votapka TV, Mcguire MS, O'Connor B, Szokol JW. Continuing Experience with Liver Resection and Vena Cava Reconstruction using Cardiopulmonary Bypass and Hypothermic Circulatory Arrest. Am Surg 2002. [DOI: 10.1177/000313480206800409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
When the suprahepatic vena cava or the hepatic vein confluence with the inferior vena cava (IVC) is obscured by tumor or a clot in the IVC extends above the liver, cross-clamping the IVC during liver or retroperitoneal resection is hazardous. This report describes a 10-year experience with ten patients who had liver (seven) or retroperitoneal (three) resections with vena cava reconstruction using cardiopulmonary bypass and hypothermic circulatory arrest. There were no perioperative deaths. Morbidity consisted of prolonged bile leak (one), pulmonary embolism (one), and stroke (one). Control of the liver was secured in six of seven patients who had a liver resection. There were three significant advantages to this technique. First, the median sternotomy provided superior exposure to the suprahepatic IVC. Second, the bypass technique avoided the risks of hemodynamic instability and prevented air embolism and sudden uncontrolled hemorrhage incurred by resection or IVC cross-clamping. Third, hypothermia provided a method of protection for residual liver function especially in the face of chronic liver disease induced by infection or chemotherapy.
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Affiliation(s)
- Stephen F. Sener
- Divisions of General
- Departments of Surgery, Northwestern University Medical School, Chicago, Illinois
| | - David J. Winchester
- Divisions of General
- Departments of Surgery, Northwestern University Medical School, Chicago, Illinois
| | - Timothy V. Votapka
- Cardiovascular-Thoracic, Northwestern University Medical School, Chicago, Illinois
- Departments of Surgery, Northwestern University Medical School, Chicago, Illinois
| | - Michael S. Mcguire
- Urologic Surgery of the Department of Surgery, Northwestern University Medical School, Chicago, Illinois
- Urology, Northwestern University Medical School, Chicago, Illinois
| | - Brent O'Connor
- Department of Anesthesia, Evanston Northwestern Healthcare, Evanston and the, Chicago, Illinois
- Anesthesia, Northwestern University Medical School, Chicago, Illinois
| | - Joseph W. Szokol
- Department of Anesthesia, Evanston Northwestern Healthcare, Evanston and the, Chicago, Illinois
- Urology, Northwestern University Medical School, Chicago, Illinois
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Hemming AW, Langham MR, Reed AI, Van Der Werf WJ, Howard RJ. Resection of the Inferior Vena Cava for Hepatic Malignancy. Am Surg 2001. [DOI: 10.1177/000313480106701110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Involvement of the inferior vena cava (IVC) by hepatic tumors, although uncommon, is considered to be unresectable by standard surgical techniques. Recent advances in hepatic surgery have made combined hepatic and vena caval resection possible. The purpose of this study is to describe the surgical techniques and early results of combined resection of the liver and IVC. From 1997 to 2000, 11 patients underwent resection of the IVC along with four to seven liver segments. Resections were carried out for hepatocellular carcinoma (four); colorectal metastases (four); and hepatoblastoma, gastrointestinal stromal tumor metastases, and squamous cell carcinoma in one patient each. Ex vivo procedures were performed twice, and total vascular isolation was used in the nine other cases. The IVC was reconstructed with ringed Gore-Tex tube graft (five), primarily (five), or with Gore-Tex patches (one). There were two early deaths: one from liver failure at 3 weeks and one from sepsis secondary to a perforated segment of small bowel 4 months postresection. One patient with a gastrointestinal stromal tumor died at 32 months of recurrent tumor and one patient with hepatocellular carcinoma is alive with recurrent tumor at 16 months. The remaining patients are alive and disease free with follow-up ranging from 3 to 40 months without evidence of IVC occlusion. Combined resection of the liver and IVC is a formidable undertaking with substantial surgical risk. However, this aggressive surgical approach offers a chance for cure in patients with tumors involving the IVC that would otherwise have a dismal prognosis.
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Affiliation(s)
- Alan W. Hemming
- Department of Surgery, University of Florida, Center for Hepatobiliary Disease, Gainesville, Florida
| | - Max R. Langham
- Department of Surgery, University of Florida, Center for Hepatobiliary Disease, Gainesville, Florida
| | - Alan I. Reed
- Department of Surgery, University of Florida, Center for Hepatobiliary Disease, Gainesville, Florida
| | - Willem J. Van Der Werf
- Department of Surgery, University of Florida, Center for Hepatobiliary Disease, Gainesville, Florida
| | - Richard J. Howard
- Department of Surgery, University of Florida, Center for Hepatobiliary Disease, Gainesville, Florida
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Vauthey JN. Hepatic colorectal metastases and extrahepatic disease. J Surg Oncol 2001; 76:243-4. [PMID: 11320514 DOI: 10.1002/jso.1172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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