Liver resection under hypothermic total vascular exclusion

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Vascular Surgery

Background:

• Centrally located liver tumors involving the inferior vena cava (IVC) or hepatic veins pose significant surgical challenges.
• Standard resection often requires total vascular exclusion (TVE), risking prolonged warm ischemia exceeding liver tolerance.
• Current application of hypothermia with TVE is infrequent despite its potential benefits.

Purpose of the Study:

• To review the role and application of hypothermic total vascular exclusion (TVE) in managing challenging liver tumors.
• To explore how hypothermic TVE can extend the feasibility of liver resections for complex cases.
• To discuss adjunct techniques like ante situm and ex vivo resections with autotransplantation.

Main Methods:

• Review of literature on hypothermic total vascular exclusion (TVE) in liver surgery.
• Discussion of historical and modern applications of hypothermia during TVE.
• Analysis of extended liver resection strategies including ante situm and ex vivo procedures.

Main Results:

• Hypothermia can mitigate the risks associated with prolonged warm ischemia during TVE for liver resections.
• Understanding and applying hypothermic TVE may expand the criteria for surgical resection of difficult liver tumors.
• Adjunct techniques further enhance the safety and applicability of hypothermic TVE.

Conclusions:

• Hypothermic total vascular exclusion (TVE) is a valuable adjunct for complex liver resections involving major vascular structures.
• This technique can potentially increase the number of patients eligible for curative liver tumor surgery.
• Further understanding and adoption of hypothermic TVE could improve outcomes in challenging hepatobiliary surgery.