Hepatic vein reconstruction using autologous vein graft for resection of advanced hepatobiliary malignancy

When advanced hepatobiliary malignancy involves the major veins that are requisite for draining venous flow from the remnant liver after hepatectomy, it may be unresectable, unless the hepatic vein involved by the tumor can be reconstructed after combined resection with hepatectomy.

Seven patients with hepatobiliary malignancy underwent hepatic vein resection and reconstruction using autologous vein grafts in our study. Five patients had patch repairs of the hepatic vein, with the gonadal vein used in 2 cases, the umbilical vein in 2, and the inferior mesenteric vein in 1. Two other patients underwent segmental reconstruction of the hepatic vein, using the inferior mesenteric vein for reconstruction of the middle hepatic vein, and the internal iliac vein for reconstruction of the right hepatic vein. Operative results and postoperative outcome, including liver function, patency, and survival, were evaluated. Literatures reporting hepatic vein reconstruction in hepatic resection, including this study, are also reviewed.

In 6 of 7 patients, autologous vein grafts were obtained from the upper abdominal operative field without making an additional skin incision. The right internal iliac vein was used in segmental reconstruction of the right hepatic vein, and the inferior mesenteric vein was used in segmental reconstruction of the middle hepatic vein, based on caliber matching. Patch repairs of the right hepatic vein were successfully performed in 2 cases, the middle hepatic vein in 2, and the left hepatic in 1, using the umbilical vein, the gonadal vein and the inferior mesenteric vein. During hepatic vein reconstruction, total hepatic vascular exclusion was required in 2 cases, and Pringle's inflow clamp with selective clamp of reconstructed hepatic vein in 5, in order to avoid massive bleeding, congestion, and air embolism. Postoperatively, there were no remarkable complications of liver dysfunction or other organ damage encountered in any of the patients. Reconstructed hepatic veins were revealed to be patent postoperatively in all cases. Six patients survived for 60-1035 days after surgery, and 1 patient died of cancer recurrence 550 days after surgery.

We conclude that hepatic vein reconstruction using an autologous vein graft can be safely and effectively performed with a suitable vascular control method for appropriately selected patients with advanced hepatobiliary cancer.