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Current trends in vena cava reconstructive techniques with major liver resection: a systematic review
Maria Baimas-George1, Christoph Tschuor1,2, Michael Watson1
1Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA.
Langenbeck'S Archives of Surgery
|September 26, 2020
Summary
Inferior vena cava (IVC) resection and reconstruction for hepatic disease have advanced, but techniques and management remain varied. Increased use of ex vivo approaches and less venovenous bypass suggest improved practices, yet consensus is needed.
Area of Science:
- Vascular Surgery
- Hepatobiliary Surgery
- Oncology
Background:
- Inferior vena cava (IVC) invasion historically indicated advanced, unresectable hepatic disease.
- Surgical and anesthetic advancements now permit IVC resection and reconstruction in select patients.
Purpose of the Study:
- To review technical variations in hepatic IVC reconstructive techniques.
- To assess post-operative management strategies for IVC resection.
Main Methods:
- Comprehensive literature search (PRISMA guidelines) for studies from January 2015 to March 2020.
- Inclusion criteria: peer-reviewed English articles, minimum three cases, hepatic IVC resection and reconstruction.
- Primary outcomes: reconstructive technique, anti-thrombotic regimen, IVC patency, infection; Secondary outcomes: complications, survival.
Main Results:
- Analysis of 351 patients from 14 articles revealed significant heterogeneity in surgical techniques and management.
- Increased utilization of ex vivo approaches and decreased use of venovenous bypass were observed compared to prior literature.
- Variability noted in anti-thrombotic strategies and post-operative patency monitoring.
Conclusions:
- Hepatic IVC reconstructive techniques and peri-operative management remain heterogeneous.
- Increased use of ex vivo methods and reduced venovenous bypass suggest evolving, potentially improved, operative and anesthetic practices.
- A dedicated registry is recommended to establish consensus on optimal management strategies.
