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[Vascular reconstruction in hepatic surgery].

S Heinrich1, J Baumgart1, J Mittler1

  • 1Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstrasse 1, 55131, Mainz, Deutschland.

Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen
|January 21, 2016
PubMed
Summary

Vascular resection and reconstruction techniques enhance liver tumor resectability. While generally safe, outcomes depend on individual tumor infiltration and prognosis, requiring careful assessment.

Keywords:
Ante situ resectionEx situ resectionIn situ coolingPortal vein reconstructionVascular resection

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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.