Combined Liver Resection and Reconstruction of the Supra-Renal Vena Cava

Azoulay, Daniel; Andreani, P.; Maggi, U.; Salloum, C.; Perdigao, Fabiano; Sebagh, Mylène; Lemoine, Antoinette; Adam, René; Castaing, Denis

doi:10.1097/01.sla.0000218092.83675.bc

Cited by 146 publications

(107 citation statements)

References 59 publications

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“…While the mean durations of THVE were 29 min to 78 min in the reports from very experienced institutes [1,2,7,8] , the mean THVE duration in the present study was only 13.4 ± 8.4 min. The mortality rates of hepatectomy with IVC resection were 4.5% to 25% in the previous reports [1][2][3][4]8,10,11,15] . In particular, the morbidity and mortality rates were quite high when standard THVE was applied frequently, even when hypothermic perfusion was used to attenuate the ischemic liver damage.…”

Section: Discussioncontrasting

confidence: 42%

“…Then, the involved IVC wall (white arrowhead in B) and the liver was resected en-bloc under modified THVE; C (intraoperative image): The involved IVC wall was cut away with scissors (arrow) between the oblique cranial (blue arrowhead) and caudal (purple arrowhead) cross-clamps; D (illustration) and E (intraoperative image): The large cut orifice of IVC was reconstructed with IMV patch graft (black arrowhead). See Figure 1D particularly when compared to those reported by other studies [1][2][3]8,10,11] . To date, only a limited number of studies of THVE for resection of liver tumors involving IVC are present in the publicly available literature, probably because the number of experiences in individual institutes has been small.…”

Section: Discussionmentioning

confidence: 73%

“…In particular, the morbidity and mortality rates were quite high when standard THVE was applied frequently, even when hypothermic perfusion was used to attenuate the ischemic liver damage. In the previous reports, the major causes of mortality were liver failure and sepsis [1,3,4,8,11] , both of which are likely to be relevant to ischemic injury of the liver and intestinal congestion since they may facilitate bacterial translocation. Of course, simple comparison to the present case series is not possible due to the differences in severity of tumor status and underlying conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Despite recent advances in liver surgery, resection for tumors involving inferior vena cava (IVC) is still challenging [1][2][3][4] . This situation requires total hepatic vascular exclusion (THVE) for combined resection of the IVC.…”

Section: Introductionmentioning

confidence: 99%

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Retrocaval liver lifting maneuver and modifications of total hepatic vascular exclusion for liver tumor resection

Ko¹,

Kirihataya²,

Yayoi³

et al. 2016

WJH

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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 Retrocaval liver lifting maneuver and modifications of total hepatic vascular exclusion for liver tumor resection Retrospective Study ORIGINAL ARTICLEmodifications, 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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Section: Discussioncontrasting

confidence: 42%

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Retrocaval liver lifting maneuver and modifications of total hepatic vascular exclusion for liver tumor resection

Ko¹,

Kirihataya²,

Yayoi³

et al. 2016

WJH

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“…Removal of the tumor without disturbing its integrity precludes traditional methods of vascular control. Facciuto et al and Azoulay et al describe several techniques for the resection of tumors at the hepatocaval confluence, including total vascular exclusion with transdiaphragmatic intrapericardial control of the cava, veno-venous bypass, and in situ hypothermic perfusion of the liver [8,9]. However, the presence of tumor within a cardiac chamber requires the application of cardiopulmonary bypass (CPB) for resection.…”

Section: Discussionmentioning

confidence: 99%

Resection and reconstruction of suprahepatic IVC and right atrium for invasive intrahepatic cholangiocarcinoma

Whang¹,

Singh²,

Facciuto³

et al. 2013

Cureus

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Liver resection combined with inferior vena cava resection and reconstruction using artificial vascular graft: A literature review

Tomimaru

Eguchi

Wada

et al. 2018

Annals of Gastroent Surgery

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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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Combined Liver Resection and Reconstruction of the Supra-Renal Vena Cava

Cited by 146 publications

References 59 publications

Retrocaval liver lifting maneuver and modifications of total hepatic vascular exclusion for liver tumor resection

Retrocaval liver lifting maneuver and modifications of total hepatic vascular exclusion for liver tumor resection

Resection and reconstruction of suprahepatic IVC and right atrium for invasive intrahepatic cholangiocarcinoma

Liver resection combined with inferior vena cava resection and reconstruction using artificial vascular graft: A literature review

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