Safety and efficacy of venous reconstruction in liver resection using cryopreserved homologous veins

Yamamoto, Masaki; Akamatsu, Nobuhisa; Hayashi, Akimasa; Togashi, Junichi; Sakamoto, Yoshihiro; Tamura, Sumihito; Hasegawa, Kiyoshi; Fukayama, Masashi; Makuuchi, Masatoshi

doi:10.1002/jhbp.488

Cited by 14 publications

(15 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The vessel grafts used for hepatic veins reconstruction include autologous saphenous veins [ 1 , 2 ], the internal jugular veins [ 3 ], the ovarian veins[ 4 – 6 ], the umbilical veins [ 6 – 8 ], artificial blood vessels [ 9 ], and allogeneic iliac vessels [ 10 , 11 ]. When using a saphenous vein, the internal jugular vein, or the ovarian vein, a normal vessel needs to be harvested from the patient, thus increasing the number of surgical sites.…”

Section: Discussionmentioning

confidence: 99%

“…Reconstruction of the hepatic vein plays a critical role in preserving more of the residual liver volume and reducing the risk of postoperative liver failure in extreme hepatectomy. Vessel grafts for reconstruction of the middle hepatic vein include an autologous saphenous vein [ 1 , 2 ], the internal jugular vein [ 3 ], the ovarian vein [ 4 – 6 ], the umbilical vein [ 6 – 8 ], an artificial vessel [ 9 ], and an allogeneic vessel [ 10 , 11 ]. The use of vessel grafts from wasted liver has advantages of less damage and more similar character for middle hepatic vein reconstruction.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Reconstruction of the middle hepatic vein using a vein graft from the resected portion of the liver

et al. 2020

View full text Add to dashboard Cite

Background The middle hepatic veins are often infiltrated by intrahepatic cholangiocarcinoma. Reconstruction of the hepatic vein plays a critical role in preserving more of the residual liver volume and reducing the risk of postoperative liver failure in extreme hepatectomy. We here report a novel way to reconstruct middle hepatic vein by using vessel grafts from wasted liver. Case presentation Case 1: A 64-year-old man was diagnosed with intrahepatic cholangiocarcinoma. The bifurcation and left branch of the portal vein were stenosed, and the root of the middle hepatic vein was infiltrated by the tumor. An extended left hepatectomy was performed, the portal vein was resected and reconstructed, and the middle hepatic vein was reconstructed by anastomosing the proximal left hepatic vein to the distal middle hepatic vein. Case 2: A 69-year-old woman was diagnosed with intrahepatic cholangiocarcinoma. The tumor was located in the left lobe of the liver and the left and middle hepatic veins were infiltrated by the tumor. An extended left hepatectomy was performed, and the left portal vein was used as a vein graft to reconstruct the middle hepatic vein. Both of the two patients’ postoperative ultrasound showed vessel graft patency. Conclusion Using a vein graft from the resected portion of the liver to reconstruct the middle hepatic vein was a useful technique and showed good result.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reconstruction of the middle hepatic vein using a vein graft from the resected portion of the liver

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Hepatic vein reconstruction for resection of hepatic tumors is a technically challenging technique which has been improved based on the experience derived from liver transplant techniques, however, has associated morbidity and mortality [17] . Patency described is 46% at 3 years, with the main causes of restenosis being local recurrence and thrombosis [18] . Factors described to influence the patency are length of the reconstruction and method of resection [18] .…”

Section: Discussionmentioning

confidence: 99%

“…Patency described is 46% at 3 years, with the main causes of restenosis being local recurrence and thrombosis [18] . Factors described to influence the patency are length of the reconstruction and method of resection [18] . Due to the postsurgical nature of the stenosis of the case presented, the approach utilized was the same used in post-transplant hepatic vein stenosis.…”

Section: Discussionmentioning

confidence: 99%

Use of drug-coated balloons in the management of a recalcitrant postsurgical hepatic vein stenosis in a pediatric patient

Parra

Brandão

2020

Radiology Case Reports

View full text Add to dashboard Cite

Drug-coated balloons (DCB) are a treatment alternative to conventional angioplasty in arterial, hemodialysis fistulas, and venous stenoses. This case report describes a child with the diagnosis of hepatoblastoma treated with chemotherapy and a right extended hepatectomy with venous reconstruction. The patient presented with signs and symptoms of portal hypertension due to a hepatic venous outflow obstruction secondary to stenosis of the surgical anastomosis. The response to conventional angioplasty was limited with frequent recurrence of symptoms. DCBs were used as an alternative prior to stent consideration aiming to assess if these devices could provide improvement of the symptoms and as a long-term therapy. The use of DCBs increased the time interval of reinterventions in comparison with conventional angioplasty. The patient eventually required stents due to recurrence of the primary disease. While this report does not provide an in-depth evaluation in terms of the efficacy and safety of DCB, this case illustrates a potential novel treatment modality to be considered for children, when stenotic venous lesions not amenable for stenting are present.

show abstract

“…Hypothermic perfusion has rendered aggressive hepatectomy with venous reconstruction for tumors involving major HVs and/or IVC to achieve R0 resection possible with satisfactory results 20,21 . Venoplasty and outflow reconstruction techniques have been studied in detail in the living‐donor liver transplantation (LDLT) setting; the suggested solution is to create larger orifices while considering graft regeneration patterns 22 .…”

Section: Discussionmentioning

confidence: 99%

Hypothermic perfusion hepatectomy for unresectable liver cancer: A single‐center experience

Yoon

Lee

Moon

et al. 2019

J Hepato Biliary Pancreat

View full text Add to dashboard Cite

Background:The resection of liver tumors that involve the hepatic veins adjacent to the vena cava or hepatic hilum is technically challenging. We present our surgical techniques and the long-term outcome of five patients with conventionally unresectable tumors. Methods: Five patients with conventionally unresectable tumors were successfully treated by "ex-situ liver resection" and "in-situ and ante-situm hypothermic liver perfusion" under total vascular exclusion and venovenous bypass. Results: These approaches allowed complete tumor removal with vascular reconstruction under a bloodless surgical field, while minimizing hepatic ischemic injury and preserving liver function. No perioperative mortalities occurred, and postoperative complications were minimal. The postoperative survival periods were limited due to the advanced malignancies in our patients, but the survival benefit was encouraging. The median postoperative survival time was 29.1 months, with the longest survival period being nearly 10 years. These approaches improved the quality of life and provided an opportunity for additional treatment. Conclusions: Hypothermic perfusion hepatectomy is a realistic option for achieving surgical cure or significantly improved survival and quality of life in patients with tumors deemed unresectable using conventional normothermic hepatectomy. These approaches can overcome the limitations of the liver's restricted normothermic ischemia tolerance or inaccessible tumor locations. K E Y W O R D Sante-situm liver resection, ex-situ liver resection, hepatectomy, hypothermic perfusion, total vascular exclusion

show abstract

Safety and efficacy of venous reconstruction in liver resection using cryopreserved homologous veins

Abstract: Aggressive venous reconstruction during hepatectomy using cryopreserved homologous veins is a feasible option with satisfactory short-term outcomes, and may be warranted to improve operative safety.

Cited by 14 publications

References 30 publications

Reconstruction of the middle hepatic vein using a vein graft from the resected portion of the liver

Reconstruction of the middle hepatic vein using a vein graft from the resected portion of the liver

Use of drug-coated balloons in the management of a recalcitrant postsurgical hepatic vein stenosis in a pediatric patient

Hypothermic perfusion hepatectomy for unresectable liver cancer: A single‐center experience

Contact Info

Product

Resources

About