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Liver resection under total vascular isolation. Variations on a theme

S Emre1, M E Schwartz, E Katz

  • 1Department of Surgery, Mount Sinai School of Medicine, New York, New York.

Annals of Surgery
|January 1, 1993
PubMed
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Total vascular isolation (TVI) of the liver enables safe surgical removal of large, complex liver tumors. This technique minimizes operative risks, allowing for successful resection of tumors near critical structures.

Area of Science:

  • Hepatobiliary Surgery
  • Surgical Oncology
  • Vascular Surgery

Background:

  • Resection of large liver tumors near critical hilar structures, hepatic veins, or the inferior vena cava (IVC) poses significant operative challenges.
  • Traditional surgical approaches may carry prohibitive risks for such complex cases.

Purpose of the Study:

  • To evaluate the safety and efficacy of total vascular isolation (TVI) of the liver during hepatic resection for large, critically located tumors.
  • To assess the feasibility of TVI in complex liver resections involving major vascular and biliary structures.

Main Methods:

  • Total vascular isolation (TVI) was performed in 16 patients undergoing liver resection for large tumors (mean diameter, 10.7 cm).
  • TVI involved clamping the suprahepatic and infrahepatic IVC and porta hepatis, with or without aortic occlusion, or selective hepatic vein clamping.

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  • Procedures included major hepatectomies and concomitant reconstruction of the portal vein, IVC, or bile duct when necessary.

    • Main Results:

    • No postoperative hepatic or renal failure occurred in the study cohort.
    • Mean intensive care unit and hospital stays were 2.8 and 12.5 days, respectively.
    • Two perioperative deaths were recorded, indicating a manageable mortality rate for complex resections.

    Conclusions:

    • Total vascular isolation (TVI) provides a safe and effective method for resecting large liver tumors in challenging locations.
    • TVI facilitates the management of complex liver resections, reducing operative risks and improving patient outcomes.