[Vascular reconstruction in hepatic surgery]

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Vascular Reconstruction

Background:

• Liver tumors can infiltrate critical vascular structures, compromising postoperative liver function.
• Tumor size and location pose challenges for complete surgical removal.

Purpose of the Study:

• To review current technical approaches and outcomes for vascular resection and reconstruction in liver surgery.
• To assess the feasibility and safety of these advanced surgical techniques.

Main Methods:

• Comprehensive literature search of Medline and Cochrane databases.
• Analysis of studies focusing on vascular resection and reconstruction in liver surgery.

Main Results:

• Portal vein resection is established, with end-to-end anastomosis or graft interposition.
• Reconstruction of the inferior vena cava and hepatic arteries is feasible, with increasing case reports.
• Advanced techniques like total vascular exclusion, in situ cooling, and ex situ resection improve resectability and ischemic tolerance.

Conclusions:

• Transplantation surgery principles for vascular reconstruction are applicable to liver surgery, enhancing tumor resectability.
• Careful individual assessment is crucial, balancing prognosis with potential morbidity.
• Vascular reconstruction improves resectability but long-term survival is impacted by tumor vascular infiltration.