Skip to main content

Advertisement

SpringerLink
Log in

Extreme liver surgery as treatment of liver tumors involving the hepatocaval confluence

  • Research Article
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Objective

Analyze the characteristics, surgical technique, morbidity and survival of patients treated with extreme liver surgery.

Materials and methods

We present a series of consecutive patients with malignant liver tumors in hepatocaval confluence treated in a single center with extreme liver surgery (April 2008–March 2015). Data were collected prospectively and analyzed with SPSS 21.0.

Results

12 patients were included. 50 % were male and 50 % were female with a mean age of 59 ± 10 years old. The median of comorbidities was 7 according to the Charlson Age Comorbidity Index. The 75 % of the tumors were metastases, most of them from colorectal cancer. Most of the patients received neoadjuvant chemotherapy and in 58 % preoperative portal embolization was performed. Major hepatectomies were performed (66.7 % extended right hepatectomy, 33.3 % left extended hepatectomy). The 83.3 % of the patients needed vascular reconstruction. Postoperative morbidity was more than grade II in 50 % of the patients according to Dindo–Clavien classification. There was no intraoperative mortality. The postoperative mortality rate at 90 days was 33 % due to hepatic failure and biliary fistula. In December 2015, 33 % of the patients are still alive with a mean survival of 19 months (13–23) with an ECOG Performance Status of 0.

Conclusion

Extreme liver surgery carries a high rate of morbidity and mortality that seem to increase with age and with higher tumor volumes, according to the literature. It is a therapeutic option to consider in patients with low comorbidity suffering from malignant neoplasms that involve the hepatocaval confluence, when no other treatment with curative intention can be performed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hatzaras I, Bischof DA, Fahy B, Cosgrove D, Pawlik TM. Treatment options and surveillance strategies after therapy for hepatocellular carcinoma. Ann Surg Oncol. 2014;21(3):758–66.

    Article  PubMed  Google Scholar 

  2. Lee H, Heo JS, Cho YB, Yun SH, Kim HC, Lee WY, et al. Hepatectomy vs radiofrequency ablation for colorectal liver metastasis: a propensity score analysis. World J Gastroenterol. 2015;21(11):3300–7.

    PubMed  PubMed Central  Google Scholar 

  3. Mossdorf A, Ulmer F, Junge K, Heidenhain C, Hein M, Temizel I, et al. Bypass during liver transplantation: anachronism or revival? Liver transplantation using a combined venovenous/portal venous bypass-experiences with 163 liver transplants in a newly established liver transplantation program. Gastroenterol Res Pract. 2015;2015:967951. doi:10.1155/2015/967951.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Budd JM, Isaac JL, Bennett J, Freeman JW. Morbidity and mortality associated with large-bore percutaneous venovenous bypass cannulation for 312 orthotopic liver transplantations. Liver Transpl. 2001;7(4):359–62.

    Article  CAS  PubMed  Google Scholar 

  5. Hemming AW, Reed AI, Langham MR Jr, Fujita S, Howard RJ. Combined resection of the liver and inferior vena cava for hepatic malignancy. Ann Surg. 2004;239:712–9 (discussion 719–21).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Azoulay D, Pascal G, Salloum C, Adam R, Castaing D, Tranecol N. Vascular reconstruction combined with liver resection for malignant tumours. Br J Surg. 2013;100(13):1764–75.

    Article  CAS  PubMed  Google Scholar 

  7. Chan AC, Chan SC, Yiu MK, Ho KL, Wong EH, Lo CH. Technical considerations for radical resection of a primary leiomyosarcoma of the vena cava. HPB (Oxford). 2012;14(8):565–8.

    Article  Google Scholar 

  8. Azoulay D, Castaing D, Smail A, Adam R, Cailliez V, Laurent A, et al. Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann Surg. 2000;231(4):480–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Azoulay D, Andreani P, Maggi U, Salloum C, Perdigao F, Sebagh M. Combined liver resection and reconstruction of the supra-renal vena cava: the Paul Brousse experience. Ann Surg. 2006;244(1):80–8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Heaney JP, Stanton WK, Halbert DS, Seidel J, Vice T. An improved technic for vascular isolation of the liver: experimental study and case reports. Ann Surg. 1966;163(2):237–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Shaw BW, Martin DJ, Marquez JM, Kang YG, Bugbee AC, Iwatsuki S, et al. Venous bypass in clinical liver transplantation. Ann Surg. 1984;200(4):524–34.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Fortner JG, Shiu MH, Kinne DW, Kim DK, Castro EB, Watson RC, et al. Major hepatic resection using vascular isolation and hypothermic perfusion. Ann Surg. 1974;180(4):644–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Hoti E, Salloum C, Azoulay D. Hepatic resection with in situ hypothermic perfusion is superior to other resection techniques. Dig Surg. 2011;28(2):94–9.

    Article  PubMed  Google Scholar 

  14. Raab R, Schlitt HJ, Oldhafer KJ, Bornscheuer A, Lang H, Pichlmayr R. Ex-vivo resection techniques in tissue-preserving surgery for liver malignancies. Langenbecks Arch Surg. 2000;385(3):179–84.

    Article  CAS  PubMed  Google Scholar 

  15. Azoulay D, Lim C, Salloum C, Andreani P, Maggi U, Bartelmaos T, et al. Complex liver resection using standard total vascular exclusion, venovenous bypass, and in situ hypothermic portal perfusion: an audit of 77 consecutive cases. Ann Surg. 2014;00:1–12.

    Google Scholar 

  16. Hannoun L, Delrivière L, Gibbs P, Borie D, Vaillant JC, Delva E. Major extended hepatic resections in diseased livers using hypothermic protection: preliminary results from the first 12 patients treated with this new technique. J Am Coll Surg. 1996;183(6):597–605.

    CAS  PubMed  Google Scholar 

  17. Dinant S, van Veen SQ, Roseboom HJ, van Vliet AK, van Gulik TM. Liver protection by hypothermic perfusion at different temperatures during total vascular exclusion. Liver Int. 2006;26(4):486–93.

    Article  PubMed  Google Scholar 

  18. FitzHenry J. The ASA classification and peri-operative risk. Ann R Coll Surg Engl. 2011;93(3):185–7.

    Article  Google Scholar 

  19. Dias-Santos D, Ferrone CR, Zheng H, Lillemoe KD, Fernández-Del Castillo C. The Charlson age comorbidity index predicts early mortality after surgery for pancreatic cancer. Surgery. 2015;157(5):881–7.

    Article  PubMed  Google Scholar 

  20. Dindo D, Demartines H, Clavien P. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Makuuchi M, Hasegawa H, Yamazaki S, Takayasu K. Four new hepatectomy procedures for resection of the right hepatic vein and preservation of the inferior right hepatic vein. Surg Gynecol Obstet. 1987;164(1):68–72.

    CAS  PubMed  Google Scholar 

  22. Hirai I, Kimura W, Fuse A, Yamamoto T, Moriya T, Mizutani M. Evaluation of inferior right hepatic vein-preserving hepatectomy with resection of the superior right hepatic vein. Hepatogastroenterology. 2006;53(70):516–20.

    PubMed  Google Scholar 

  23. Nakamura S, Sakaguchi S, Kitazawa T, Suzuki S, Koyano K, Muro H. Hepatic vein reconstruction for preserving remnant liver function. Arch Surg. 1990;125(11):1455–9.

    Article  CAS  PubMed  Google Scholar 

  24. Hemming AW, Reed AI, Langham MR, Fujita S, van der Werf WJ, Howard RJ. Hepatic vein reconstruction for resection of hepatic tumors. Ann Surg. 2002;235(6):850–8.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Soejima Y, Matsumoto T, Shirabe K, Maehara Y. Tube cavoplasty using autologous vein grafts for resected inferior vena cava reconstruction. Surg Today. 2013;43(4):452–5.

    Article  PubMed  Google Scholar 

  26. Shimoda M, Marubashi S, Dono K, Miyamoto A, Takeda Y, Nagano H, et al. Utilization of autologous vein graft for replacement of the inferior vena cava in living-donor liver transplantation for obliterative hepatocavopathy. Transpl Int. 2007;20(9):804–7.

    Article  PubMed  Google Scholar 

  27. Ohwada S, Hamada K, Kawate S, Sunose Y, Tomizawa N, Yamada T, et al. Left renal vein graft for vascular reconstruction in abdominal malignancy. World J Surg. 2007;31(6):1215–20.

    Article  PubMed  Google Scholar 

  28. Aoki T, Sugawara Y, Imamura H, Seyama Y, Minagawa M, Hasegawa K, et al. Hepatic resection with reconstruction of the inferior vena cava or hepatic venous confluence for metastatic liver tumor from colorectal cancer. J Am Coll Surg. 2004;198(3):366–72.

    Article  PubMed  Google Scholar 

  29. Hemming AW, Mekeel KL, Zendejas I, Kim RD, Sicklick JK, Reed AI. Resection of the liver and inferior vena cava for hepatic malignancy. J Am Coll Surg. 2013;217(1):115–24 (discussion 124–5).

    Article  PubMed  Google Scholar 

  30. Arii S, Teramoto K, Kawamura T, Takamatsu S, Sato E, Nakamura N, et al. Significance of hepatic resection combined with inferior vena cava resection and its reconstruction with expanded polytetrafluoroethylene for treatment of liver tumors. J Am Coll Surg. 2003;196(2):243–9.

    Article  PubMed  Google Scholar 

  31. Wachtel H, Jackson BM, Bartlett EK, Karakousis GC, Roses RE, Bavaria JE, et al. Resection of primary leiomyosarcoma of the inferior vena cava (IVC) with reconstruction: a case series and review of the literature. J Surg Oncol. 2015;111(3):328–33.

    Article  PubMed  Google Scholar 

  32. Azoulay D, Maggi U, Lim C, Malek A, Compagnon P, Salloum C, et al. Liver resection using total vascular exclusion of the liver preserving the caval flow, in situ hypothermic portal perfusion and temporary porta-caval shunt: a new technique for central tumors. Hepatobiliary Surg Nutr. 2014;3(3):149–53.

    PubMed  PubMed Central  Google Scholar 

  33. Díaz-Rubio EG. Biomarkers and anti-EGFR therapies for KRAS wild-type tumors in metastatic colorectal cancer patients. An R Acad Nac Med. 2009;126(2):243–57 (discussion 258–62).

    Google Scholar 

  34. Siena S, Sartore-Bianchi A, di Nicolantonio F, Balfour J, Bardelli A. Biomarkers predicting clinical outcome of epidermal growth factor receptor-targeted therapy in metastatic colorectal cancer. J Natl Cancer Inst. 2009;101(19):1308–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. László L. Predictive and prognostic factors in the complex treatment of patients with colorectal cancer. Magy Onkol. 2010;54(4):383–94.

    Article  PubMed  Google Scholar 

  36. Poston GJ, Adam R, Alberts S, Curley S, Figueras J, Haller D, et al. OncoSurge: a strategy for improving resectability with curative intent in metastatic colorectal cancer. J Clin Oncol. 2005;23(28):7125–34.

    Article  PubMed  Google Scholar 

  37. Eker B, Ozaslan E, Karaca H, Berk V, Bozkurt O, Inanc M, et al. Factors affecting prognosis in metastatic colorectal cancer patients. Asian Pac J Cancer Prev. 2015;16(7):3015–21.

    Article  PubMed  Google Scholar 

  38. Kuo IM, Huang SF, Chiang JM, Yeh CY, Chan KM, Chen JS, et al. Clinical features and prognosis in hepatectomy for colorectal cancer with centrally located liver metastasis. World J Surg Oncol. 2015;13(1):92.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Frankel TL, d’Angelica MI. Hepatic resection for colorectal metastases. J Surg Oncol. 2014;109(1):2–7.

    Article  PubMed  Google Scholar 

  40. Brouquet A, Nordlinger B. Neoadjuvant therapy of colorectal liver metastases: lessons learned from clinical trials. J Surg Oncol. 2010;102(8):932–6.

    Article  PubMed  Google Scholar 

  41. Adam R, Lucidi V, Bismuth H. Hepatic colorectal metastases: methods of improving resectability. Surg Clin North Am. 2004;84(2):659–71.

    Article  PubMed  Google Scholar 

  42. Nuzzo G, Giordano M, Giuliante F, Lopez-Ben S, Albiol M, Figueras J. Complex liver resection for hepatic tumours involving the inferior vena cava. Eur J Surg Oncol. 2011;37(11):921–7.

    Article  CAS  PubMed  Google Scholar 

  43. Malde DJ, Khan A, Prasad KR, Toogood GJ, Lodge JA. Inferior vena cava resection with hepatectomy: challenging but justified. HPB (Oxford). 2011;13(11):802–10.

    Article  Google Scholar 

  44. Russell MC. Complications following hepatectomy. Surg Oncol Clin N Am. 2015;24(1):73–96.

    Article  PubMed  Google Scholar 

  45. Floyd J, Mirza I, Sachs B, Perry MC. Hepatotoxicity of chemotherapy. Semin Oncol. 2006;33(1):50–67.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain

    C. Codony, S. López-Ben, M. Albiol, L. Falgueras, E. Castro, A. Codina-Barreras, M. Casellas, J. Gil, A. Codina-Cazador & J. Figueras

  2. Facultat de Medicina, Universitat de Girona, Girona, Spain

    S. López-Ben, M. Albiol, L. Falgueras, E. Castro & A. Codina-Cazador

  3. Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain

    J. Figueras

Authors
  1. C. Codony
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. López-Ben
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Albiol
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Falgueras
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Castro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Codina-Barreras
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Casellas
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Gil
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. Codina-Cazador
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. J. Figueras
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Codony.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

This study has been approved by the ethics committee of Hospital Universitari Doctor Josep Trueta de Girona in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Codony, C., López-Ben, S., Albiol, M. et al. Extreme liver surgery as treatment of liver tumors involving the hepatocaval confluence. Clin Transl Oncol 18, 1131–1139 (2016). https://doi.org/10.1007/s12094-016-1495-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-016-1495-z

Keywords

Search

Navigation