Gefäßrekonstruktionen in der Leberchirurgie

Heinrich, Stefan; Baumgart, Janine; Mittler, Jens; Lang, Hauke

doi:10.1007/s00104-015-0144-3

Cited by 12 publications

(6 citation statements)

References 29 publications

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“…It is noteworthy that we had a 0% mortality rate after our ante situm resections. The experience with ante situm resections for iCCA is limited; mostly case reports or case series are available [17,19,21,44,45]. Without doubt, the surgical procedure is challenging due to the use of an extracorporeal bypass, in situ cold perfusion and complex vascular reconstruction of the IVC and hepatic veins.…”

Section: Discussionmentioning

confidence: 99%

Complex Liver Resections for Intrahepatic Cholangiocarcinoma

Reese

Pagel

Bause

et al. 2021

JCM

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The only curative treatment option for intrahepatic cholangiocarcinoma (iCCA) is liver resection. Due to central tumor localization and vascular invasion, complex liver resections play an important role in curative treatment. However, the long-term outcomes after complex liver resection are not known. Methods: A retrospective cohort study was conducted for all patients undergoing liver surgery for iCCA. Complex liver resections included ante situm resections, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and major liver resection with vascular reconstructions. Results: Forty-nine patients (34%) received complex liver resection, 66 patients (46%) received conventional liver resection and 28 patients (20%) were not resectable during exploration. Preoperative characteristics were not different between the groups, except for Union for International Cancer Control (UICC) stages. The postoperative course for complex liver resections was associated with more complications and perioperative mortality. However, long-term survival was not different between complex and conventional resections. Independent risk factors for survival were R0 resections and UICC stage. Four patients underwent ante situm resection without any mortality. Conclusions: Complex liver resections are justified in selected patients and survival is comparable with conventional liver resections. Survival in iCCA is affected by UICC stage or resections margins and not by the complexity of the case.

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Section: Discussionmentioning

confidence: 99%

Complex Liver Resections for Intrahepatic Cholangiocarcinoma

Reese

Pagel

Bause

et al. 2021

JCM

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“…The broad experience with hepatic artery resection and reconstruction has been gained from liver transplantation (especially living-donor liver transplantation) and surgery of perihilar cholangiocarcinoma [ 79 ]. Initial reports of arterial reconstruction within oncological major liver resections were not encouraging because of anastomotic problems (stenosis, occlusion) and unfavorable oncological long-term results.…”

Section: Reconstruction Of the Hepatic Inflowmentioning

confidence: 99%

“…Similar to other vascular resections in liver surgery, a good preoperative imaging combined with detailed knowledge of anatomy is essential for planning the resection with avoiding venous congestion and outflow impairment [ 79 ]. Recent publications report on the potential advantage of preoperative planning based on three-dimensional visualization of the liver [ 94 , 95 ].…”

Section: Reconstruction Of the Vascular Hepatic Outflowmentioning

confidence: 99%

Vascular surgery in liver resection

Radulova-Mauersberger

Weitz

Riediger

2021

Langenbecks Arch Surg

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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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“…Although it is the only way of facilitating complete resection in case of vascular invasion, there are concerns of high postoperative morbidity and mortality following vascular reconstruction, including hemorrhage and liver failure, which might offset the survival advantage gained from complete tumor removal. However, thanks to technical improvements in microvascular anastomoses and to a growing experience with liver transplants in many centers, the surgical approaches for hilar cholangiocarcinoma have generally become more aggressive in recent years, and thus, the number of studies assessing feasibility, safety, and oncological effectiveness of arterial resection and reconstruction has grown [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Surgery With Arterial Resection for Hilar Cholangiocarcinoma: Protocol for a Systematic Review and Meta-analysis

et al. 2021

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Background In light of recent advances in multimodality treatment, an analysis of vascular resection outcomes in surgery for hilar cholangiocarcinoma is lacking. Objective The aim of this meta-analysis is to summarize the currently available evidence on outcomes of patients undergoing arterial resection for the treatment of hilar cholangiocarcinoma. Methods A systematic literature search in the databases PubMed/MEDLINE, Cochrane Library, and CINAHL, and the trial registries ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform will be carried out. Predefined outcomes are mortality (100-day and in-hospital), morbidity (Clavien-Dindo classification, any type of complication), vascular complications (thrombosis or stenosis of the portal vein or hepatic artery, pseudoaneurysms), liver failure, postoperative bleeding, duration of surgery, reoperation rate, length of hospital stay, survival time, actuarial survival (2-, 3-, and 5-year survival), complete/incomplete resection rates, histologic arterial invasion, and lymph node positivity (number of positive lymph nodes and lymph node ratio). Results Database searches will commence in December 2020. The meta-analysis will be completed by December 2021. Conclusions Our findings will enable us to present the current evidence on the feasibility, safety, and oncological effectiveness of surgery for hilar cholangiocarcinoma with arterial resection. Our data will support health care professionals and patients in their clinical decision-making. Trial Registration PROSPERO 223396; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=223396 International Registered Report Identifier (IRRID) DERR1-10.2196/31212

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Gefäßrekonstruktionen in der Leberchirurgie

Cited by 12 publications

References 29 publications

Complex Liver Resections for Intrahepatic Cholangiocarcinoma

Complex Liver Resections for Intrahepatic Cholangiocarcinoma

Vascular surgery in liver resection

Surgery With Arterial Resection for Hilar Cholangiocarcinoma: Protocol for a Systematic Review and Meta-analysis

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