Surgical Resection of Malignancies Invading Inferior Vena Cava Level I and II. Issues Still Need to Be Discussed

Vicente, Emilio; Quijano, Yolanda; Ielpo, Benedetto; Durán, Hipólito; Dı́az, Eduardo; Fabra, Isabel; Malavé, L.; Ferri, Valentina; Ferronetti, Antonio; Caruso, Riccardo

doi:10.21873/anticanres.11594

Cited by 9 publications

(9 citation statements)

References 12 publications

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“…One article was omitted due to duplicate data [33]. This resulted in 14 articles included in the final qualitative synthesis [14,[34][35][36][37][38][39][40][41][42][43][44][45][46]. All 14 articles were case series and thus uncontrolled-observational trials.…”

Section: Literature Reviewmentioning

confidence: 99%

“…IVC resection techniques varied between articles with details only described for 203 of 350 patients. About one-third of patients (32%) underwent a primary caval repair [35,36,39,[41][42][43]45]. Two studies described ligation without repair which was only 7% of described cases [36,44].…”

Section: Ivc Resection and Reconstructionmentioning

confidence: 99%

“…Two studies described ligation without repair which was only 7% of described cases [36,44]. Forty percent of patients had synthetic graft replacement, typically with PTFE graft [14,34,35,42,43,45,46]. Autologous graft replacement was another described technique using either the saphenous vein or inferior mesenteric vein (IMV) for 17% of cases [36,43] .P a t c hc l o s u r ew a so n l yu s e di n 3% of cases with either synthetic PTFE patches or an autologous vein patch with the IMV [34,36,39,41,43].…”

Section: Ivc Resection and Reconstructionmentioning

confidence: 99%

“…The use and description of peri-operative and post-operative antithrombotics were not provided in a majority of examined studies. Three studies provided adequate detail: (1) prophylactic heparin 30 days post-operatively; (2) prophylactic low molecular weight heparin (LMWH) from post-operative day two until discharge; and (3) LMWH in hospital followed by coumadin at discharge for 90 days (Table 6 in Appendix 3) [35,36,46].…”

Section: Ivc Resection and Reconstructionmentioning

confidence: 99%

“…Two studies found post-operative thromboses in the reconstructed IVC [35,46]. Two studies found outflow stenosis with subsequent balloon dilatation for treatment [36,42].…”

Section: Venous Patency and Infectionmentioning

confidence: 99%

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Current trends in vena cava reconstructive techniques with major liver resection: a systematic review

Baimas-George

Tschuor

Watson

et al. 2020

Langenbecks Arch Surg

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Purpose: Historically, invasion of the inferior vena cava (IVC) represented advanced and often unresectable hepatic disease. With surgical and anesthetic innovations, IVC resection and reconstruction have become feasible in selected patients. This review assesses technical variations in reconstructive techniques and post-operative management. Methods: A comprehensive literature search was performed according to PRISMA. Inclusion criteria were (i) peer-reviewed articles in English; (ii) at least three cases; (iii) hepatic IVC resection and reconstruction (January 2015-March 2020). Primary outcomes were reconstructive technique, anti-thrombotic regimen, post-operative IVC patency, and infection. Secondary outcomes included post-operative complications and malignant disease survival. Results: Fourteen articles were included allowing for investigation of 351 individual patients. Analysis demonstrated significant heterogeneity in surgical reconstructive technique, anti-thrombotic management, and postoperative monitoring of patency. There was increased utilization of ex vivo approaches and decreased use of venovenous bypass compared with previously published reviews. Conclusion: This review of literature published between 2015 and 2020 reveals persistent heterogeneity of hepatic IVC reconstructive techniques and peri-operative management. Increased utilization of ex vivo approaches and decreased use of venovenous bypass point towards improved operative techniques, peri-operative management, and anesthesia. In order to gain evidence for consensus on management, a registry would be beneficial.

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Section: Literature Reviewmentioning

confidence: 99%

Section: Ivc Resection and Reconstructionmentioning

confidence: 99%

Section: Ivc Resection and Reconstructionmentioning

confidence: 99%

Section: Ivc Resection and Reconstructionmentioning

confidence: 99%

“…Two studies found post-operative thromboses in the reconstructed IVC [35,46]. Two studies found outflow stenosis with subsequent balloon dilatation for treatment [36,42].…”

Section: Venous Patency and Infectionmentioning

confidence: 99%

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Current trends in vena cava reconstructive techniques with major liver resection: a systematic review

Baimas-George

Tschuor

Watson

et al. 2020

Langenbecks Arch Surg

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Reconstruction of Inferior Vena Cava by Autologous Great Saphenous Vein Grafts in Liver Surgery

Qiu

et al. 2023

World j. surg.

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Background To secure surgical margin for hepatic lesion with involvement of the inferior vena cava (IVC), combined radical liver resection and IVC replacement are required. A novel method of replacing IVC by newly customized autologous great saphenous vein (GSV) grafts was introduced by this study. This study aimed at reporting the feasibility and outcome of this novel technique. Methods From January 2014 to January 2021, all consecutive patients who underwent concomitant hepatectomy and IVC replacement by autogenous GSV graft were enrolled in this study. Technical insights, intraoperative details, demographic data, postoperative complication, graft patency and survival data were collected and analyzed. Results Concomitant hepatectomy/autotransplantation (ERAT) with IVC replacement by autogenous GSV graft was successful in 47 patients and there was no 30‐day mortality. There were 8 out of the 47 patients whose retrohepatic venae cavae were completely invaded by the lesion and their reconstructed IVCs were totally made from GSV grafts. The other 39 patients whose IVCs were partially invaded had their IVCs reconstructed by both the unaffected part of the IVC wall and newly customized GSV graft. Postoperative complications classified as Clavien‐Dindo grade II, III A and III B were observed in 10, 7 and 3 patients, respectively. The median follow‐up months were 35 months (29–80 months). No patient developed thrombosis of the graft and 100% patency of the IVC was observed throughout the study. Conclusion In selected patients, hepatectomy/ERAT with IVC replacement by autogenous GSV graft is safe and feasible. The newly customized autologous GVS graft was ideal for reconstruction of the IVC in liver surgery.

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Left renal vein graft and in situ hepatic perfusion in hepatectomy for complete tumor invasion of hepatic veins: hemodynamic optimization and surgical technique

López-López

Garcı́a-López

Eshmuminov³

et al. 2022

Langenbecks Arch Surg

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Purpose Assessing hepatic vein reconstruction using a left renal vein graft and in situ hypothermic liver perfusion in an extended liver resection. Methods Patients included in this study were those with liver tumors undergoing curative surgery with resection and reconstruction of hepatic veins. Hepatic vein was reconstructed using a left renal vein graft. We describe the technical aspects of liver resection and vascular reconstruction, the key aspects of hemodynamic management, and the use of in situ hypothermic liver preservations during liver transection (prior to and during vascular clamping). Results The right hepatic vein was reconstructed with a median left renal venal graft length of 4.5 cm (IQR, 3.1–5.2). Creatinine levels remained within normal limits in the immediate postoperative phase and during follow-up. Median blood loss was 500 ml (IQR, 300–1500) and in situ perfusion with cold ischemia was 67 min (IQR, 60.5–77.5). The grafts remained patent during the follow-up with no signs of thrombosis. No major postoperative complications were observed. Conclusion Left renal vein graft for the reconstruction of a hepatic vein and in situ hypothermic liver perfusion are feasible during extended liver resection.

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Surgical Resection of Malignancies Invading Inferior Vena Cava Level I and II. Issues Still Need to Be Discussed

Abstract: Surgical resection with combined inferior vena cava resection can be performed in selected patients with acceptable morbidity and mortality in light of the recent advancement in surgical technique.

Cited by 9 publications

References 12 publications

Current trends in vena cava reconstructive techniques with major liver resection: a systematic review

Current trends in vena cava reconstructive techniques with major liver resection: a systematic review

Reconstruction of Inferior Vena Cava by Autologous Great Saphenous Vein Grafts in Liver Surgery

Left renal vein graft and in situ hepatic perfusion in hepatectomy for complete tumor invasion of hepatic veins: hemodynamic optimization and surgical technique

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