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Ante-situm hepatic resection for tumors involving the confluence of hepatic veins and IVC

Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Background

For patients with bulky liver tumors that have invaded all three hepatic veins at the hepatic venous confluence to the inferior vena cava (IVC), reconstruction of at least one hepatic vein outlet to the IVC is necessary.

Methods

To effectively treat these tumors, we performed 7 ante-situm liver resections. The ante-situm position provides surgeons with excellent visualization of the anatomical structures that should be maintained in the remnant liver. In addition, replacement of the involved IVC by a ringed expanded polytetrafluoroethylene (ePTFE) graft can be safely completed.

Results

Because of the far-advanced malignancies of our 7 patients, the survival periods after surgery were limited, but the survival benefits of the procedure were not disappointing. From what has been reported in the literature, the survival periods in our patients appear to justify the employment of the procedure even when compared with survivals in patients who have less complex tumor extensions.

Conclusion

Because of the complexity of this procedure, a team of surgeons familiar with liver surgery and liver transplantation in a specialized hepatobiliary center is required. However, we anticipate that this procedure will be feasible and justified for selected patients in whom tumor invasion at the confluence of all three hepatic veins and the IVC is too extensive to treat with other surgical procedures.

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Acknowledgments

Surgery with patients #1–5 was performed at the Department of Gastroenterological Surgery, Kyoto University Graduate School of Medicine; surgery for patients #6 and 7 was performed at the Department of Gastroenterological Surgery, Akita University Graduate School of Medicine. The author would like to thank the staff at both institutes for their excellent assistance in surgery and postoperative patient management.

Conflict of interest

I declare that I have no conflict of interest.

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Correspondence to Yuzo Yamamoto.

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Yamamoto, Y. Ante-situm hepatic resection for tumors involving the confluence of hepatic veins and IVC. J Hepatobiliary Pancreat Sci 20, 313–323 (2013). https://doi.org/10.1007/s00534-012-0525-7

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  • DOI: https://doi.org/10.1007/s00534-012-0525-7

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