ABSTRACT
PURPOSE: Treatment of malignancies invading the hepatic veins/inferior vena cava is a surgical challenge. An ante situm technique allows luxation of the liver in front of the situs to perform tumor resection. Usually, cold perfusion and veno-venous bypass are applied. Our experience with modified ante situm resection relying only on total vascular occlusion is reported. METHODS: Retrospective analysis on an almost 15-year experience with ante situm resection without application of cold perfusion or veno-venous bypass RESULTS: The ante situm technique was applied on eight patients. Five individuals were treated due to intrahepatic cholangiocellular cancer and one case each for mixed cholangio-/hepatocellular carcinoma, colorectal liver metastasis, and pheochromocytoma. Trisectorectomy (n = 4), left hemihepatectomy, right hepatectomy, atypical resection, or mesohepatectomy (each n = 1) were performed, combined with dissection of suprahepatic/retrohepatic vena cava/hepatic veins. Venous reconstruction was achieved by reimplantation of hepatic veins with/without vascular replacement using allogeneic donor veins or PTFE grafts. Median total vascular occlusion of the liver was 23 min. Severe morbidity occurred in three patients (Dindo-Clavien > 3A). R0 status was achieved in six cases with a median overall survival of 33.5 months. CONCLUSIONS: Ante situm liver resection can be applied without cold perfusion nor veno-venous bypass with acceptable morbidity and mortality. However, this procedure remains challenging even for the experienced hepato-pancreato-biliary surgeon.
Subject(s)
Cholangiocarcinoma/pathology , Hepatectomy/methods , Hepatic Veins/surgery , Liver Neoplasms/pathology , Liver Neoplasms/surgery , Vena Cava, Inferior/surgery , Aged , Carcinoma, Hepatocellular/diagnostic imaging , Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/surgery , Cholangiocarcinoma/diagnostic imaging , Cholangiocarcinoma/surgery , Female , Follow-Up Studies , Germany , Hepatic Veins/pathology , Humans , Hypothermia, Induced , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/mortality , Magnetic Resonance Imaging/methods , Male , Middle Aged , Neoplasm Invasiveness/pathology , Neoplasm Staging , Quality Improvement , Retrospective Studies , Risk Assessment , Sampling Studies , Tomography, X-Ray Computed/methods , Treatment Outcome , Vascular Neoplasms/pathology , Vascular Neoplasms/secondary , Vascular Neoplasms/surgery , Vascular Surgical Procedures/methods , Vena Cava, Inferior/pathologyABSTRACT
Total vascular occlusion (TVO) of the liver was used during parenchyma resection in two patients with large hepatoma located near hepatic vein or inferior vena cava. This technique was achieved by clamping the porta hepatis as well as suprahepatic and infrahepatic IVC. Durations of TVO were 15 and 25 minutes respectively. Three and four units of packed RBC were transfused for each patient. Postoperative hepatic or renal failure did not occur. The technique of TVO is easy and safe for resection of large and critically located tumors that would otherwise present operative risk.
