Skip to main content

Advertisement

SpringerLink
Log in

Liver resection with concomitant inferior vena cava resection: experiences without veno-venous bypass

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Liver resection offers the chance of a cure for liver cancer. However, when extended hepatectomies were performed in combination with resection of the inferior vena cava (IVC), the procedures were reported to have a surgical mortality rate in excess of 5 %. While most of these operations were performed with the use of veno-venous bypass, this study presents our experience performing the procedure without the bypass.

Methods

Data were collected from a prospectively maintained database. A retrospective evaluation of a consecutive series of concomitant IVC and liver resections was performed.

Results

Five hundred and seventy-five liver resections were performed between June 2008 and November 2011. Eleven patients (1.9 %) underwent concomitant IVC and liver resections. One patient required segmental IVC replacement, and four IVC defects were closed using a bovine pericardial patch without bypass. Only one patient had histologically confirmed IVC invasion. There was no postoperative mortality. Nine postoperative complications occurred in five patients. No complications in terms of IVC patency were seen. Five patients had disease recurrence, one of whom died within 12 months of surgery.

Conclusion

Concomitant liver and IVC resection is safe without using a bypass procedure, with acceptable short-term results. Meticulous technique, careful patient selection and a specialized anesthetic team are key to obtaining low postoperative morbidity and mortality rates and an acceptable oncological outcome.

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
Fig. 4

Similar content being viewed by others

References

  1. Tamandl D, Gruenberger B, Herberger B, et al. Selective resection of colorectal liver metastases. Eur J Surg Oncol. 2007;33(2):174–82.

    Article  CAS  PubMed  Google Scholar 

  2. Jung H, Lee KU, Shin WY, Ahn H. Treatment outcomes of surgical resection for hepatocellular carcinoma with inferior vena cava invasion and/or thrombosis. Hepatogastroenterology. 2011;58(110–111).

    Google Scholar 

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

    Article  Google Scholar 

  4. Azoulay D, Andreani P, Maggi U, et al. Combined liver resection and reconstruction of the supra-renal vena cava: the Paul Brousse experience. Ann Surg. 2006;244(1):80–8.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Dubay D, Gallinger S, Hawryluck L, Swallow C, McCluskey S, McGilvray I. In situ hypothermic liver preservation during radical liver resection with major vascular reconstruction. Br J Surg. 2009;96(12):1429–36.

    Article  CAS  PubMed  Google Scholar 

  6. Madariaga JR, Fung J, Gutierrez J, Bueno J, Iwatsuki S. Liver resection combined with excision of vena cava. J Am Coll Surg. 2000;191(3):244–50.

    Article  CAS  PubMed  Google Scholar 

  7. Tanaka K, Matsuyama R, Takeda K, Matsuo K, Nagano Y, Endo I. Aggressive liver resection including major-vessel resection for colorectal liver metastases. World J Hepatol. 2009;1(1):79–89.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Settmacher U, Thelen A, Jonas S, Husmann I, Heise M, Neuhaus P. Resection and reconstruction of the retrohepatic vena cava in combination with liver resections. Zentralbl Chir. 2005;130(2):104–8.

    Article  CAS  PubMed  Google Scholar 

  9. Machado MA, Herman P, Bacchella T, Machado MC. Resection and reconstruction of retrohepatic vena cava without venous graft during major hepatectomies. J Surg Oncol. 2007;96(1):73–6.

    Article  PubMed  Google Scholar 

  10. Fu SY, Lau WY, Li AJ, et al. Liver resection under total vascular exclusion with or without preceding Pringle manoeuvre. Br J Surg. 2010;97(1):50–5.

    Article  PubMed  Google Scholar 

  11. 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(5):712–9 (discussion 719–721).

    Article  PubMed Central  PubMed  Google Scholar 

  12. 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 

  13. Sarmiento JM, Bower TC, Cherry KJ, Farnell MB, Nagorney DM. Is combined partial hepatectomy with segmental resection of inferior vena cava justified for malignancy? Arch Surg. 2003;138(6):624–30 (discussion 630–621).

    Article  PubMed  Google Scholar 

  14. Lodge JP, Ammori BJ, Prasad KR, Bellamy MC. Ex vivo and in situ resection of inferior vena cava with hepatectomy for colorectal metastases. Ann Surg. 2000;231(4):471–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Kim Z, Jeong GA, Chung JC, Chu CW, Shin EJ, Kim HC. Ante-situm liver resection in recurrent liver metastasis from colorectal cancer. Hepatogastroenterology. 2009;56(90):508–11.

    PubMed  Google Scholar 

  16. Gurusamy KS, Koti R, Pamecha V, Davidson BR. Veno-venous bypass versus none for liver transplantation. Cochrane Database Syst Rev. 2011;3:CD007712.

    PubMed  Google Scholar 

  17. Asai K, Watanabe M, Matsukiyo H, et al. Combined hepatic resection with the inferior vena cava and diaphragm and reconstruction using an equine pericardial patch: report of a case. Surg Today. 2011;41(12):1670–3.

    Article  PubMed  Google Scholar 

  18. Wilson RJ, Davies S, Yates D, Redman J, Stone M. Impaired functional capacity is associated with all-cause mortality after major elective intra-abdominal surgery. Br J Anaesth. 2010;105(3):297–303.

    Article  CAS  PubMed  Google Scholar 

  19. Smith TB, Stonell C, Purkayastha S, Paraskevas P. Cardiopulmonary exercise testing as a risk assessment method in non cardio-pulmonary surgery: a systematic review. Anaesthesia. 2009;64(8):883–93.

    Article  CAS  PubMed  Google Scholar 

  20. Hashimoto T, Minagawa M, Aoki T, et al. Caval invasion by liver tumor is limited. J Am Coll Surg. 2008;207(3):383–92.

    Article  PubMed  Google Scholar 

  21. van den Broek MA, Olde Damink SW, Dejong CH, et al. Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment. Liver Int. 2008;28(6):767–80.

    Article  PubMed  Google Scholar 

  22. Li X, Guo Y, Ziegler KR, et al. Current usage and future directions for the bovine pericardial patch. Ann Vasc Surg. 2011;25(4):561–8.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Roberts I, Shakur H, Afolabi A, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011;377(9771):1096–101, 1101.e1091–2.

    Google Scholar 

  24. Johnson M, Mannar R, Wu AV. Correlation between blood loss and inferior vena caval pressure during liver resection. Br J Surg. 1998;85(2):188–90.

    Article  CAS  PubMed  Google Scholar 

  25. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228–47.

    Article  CAS  PubMed  Google Scholar 

  26. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.

    Article  PubMed  Google Scholar 

  27. Dindo D, Demartines N, Clavien PA. 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 Central  PubMed  Google Scholar 

  28. Grunhagen DJ, Fenwick SW, Poston GJ, Malik HZ. Biliary reconstruction when the liver hilum is inaccessible: the anterior approach. Eur J Surg Oncol. 2012;38(6):543–7.

    Google Scholar 

  29. de Haas RJ, Wicherts DA, Andreani P, et al. Impact of expanding criteria for resectability of colorectal metastases on short- and long-term outcomes after hepatic resection. Ann Surg. 2011;253(6):1069–79.

    Article  PubMed  Google Scholar 

  30. Stockmann M, Lock JF, Malinowski M, Niehues SM, Seehofer D, Neuhaus P. The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery. HPB (Oxford). 2010;12(2):139–46.

    Article  Google Scholar 

  31. Asiyanbola B, Chang D, Gleisner AL, et al. Operative mortality after hepatic resection: are literature-based rates broadly applicable? J Gastrointest Surg. 2008;12(5):842–51.

    Article  PubMed  Google Scholar 

  32. Bower TC, Nagorney DM, Cherry KJ Jr, et al. Replacement of the inferior vena cava for malignancy: an update. J Vasc Surg. 2000;31(2):270–81.

    Article  CAS  PubMed  Google Scholar 

  33. Gruenberger B, Scheithauer W, Punzengruber R, Zielinski C, Tamandl D, Gruenberger T. Importance of response to neoadjuvant chemotherapy in potentially curable colorectal cancer liver metastases. BMC Cancer. 2008;8:120.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Folprecht G, Gruenberger T, Bechstein WO, et al. Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial. Lancet Oncol. 2010;11(1):38–47.

    Article  CAS  PubMed  Google Scholar 

  35. Garcia-Foncillas J, Diaz-Rubio E. Progress in metastatic colorectal cancer: growing role of cetuximab to optimize clinical outcome. Clin Transl Oncol. 2010;12(8):533–42.

    Article  CAS  PubMed  Google Scholar 

  36. Dhir M, Lyden ER, Wang A, Smith LM, Ullrich F, Are C. Influence of margins on overall survival after hepatic resection for colorectal metastasis: a meta-analysis. Ann Surg. 2011;254(2):234–42.

    Article  PubMed  Google Scholar 

  37. Bodingbauer M, Tamandl D, Schmid K, Plank C, Schima W, Gruenberger T. Size of surgical margin does not influence recurrence rates after curative liver resection for colorectal cancer liver metastases. Br J Surg. 2007;94(9):1133–8.

    Article  CAS  PubMed  Google Scholar 

  38. Tamandl D, Herberger B, Gruenberger B, Puhalla H, Klinger M, Gruenberger T. Influence of hepatic resection margin on recurrence and survival in intrahepatic cholangiocarcinoma. Ann Surg Oncol. 2008;15(10):2787–94.

    Article  PubMed  Google Scholar 

  39. Lordan JT, Karanjia ND. ‘Close shave’ in liver resection for colorectal liver metastases. Eur J Surg Oncol. 2010;36(1):47–51.

    Article  CAS  PubMed  Google Scholar 

  40. Maeba T, Okano K, Mori S, et al. Extent of pathologic invasion of the inferior vena cava in resected liver cancer compared with possible caval invasion diagnosed by preoperative images. J Hepatobiliary Pancreat Surg. 2000;7(3):299–305.

    Article  CAS  PubMed  Google Scholar 

  41. Emond JC, Kelley SD, Heffron TG, Nakagawa T, Roberts JP, Lim RC Jr. Surgical and anesthetic management of patients undergoing major hepatectomy using total vascular exclusion. Liver Transpl Surg. 1996;2(2):91–8.

    Article  CAS  PubMed  Google Scholar 

  42. Kim Z, Jeong GA, Chung JC, Chu CW, Kim HC, Kim SH. Modified right lobe graft with bovine pericardium for middle hepatic vein reconstruction. Hepatogastroenterology. 2009;56(91–92):854–6.

    PubMed  Google Scholar 

  43. Wilson J, Davies S. Improving surgical outcomes: it is the destination not the journey. Crit Care. 2010;14(4):177.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Snowden CP, Prentis JM, Anderson HL, et al. Submaximal cardiopulmonary exercise testing predicts complications and hospital length of stay in patients undergoing major elective surgery. Ann Surg. 2010;251(3):535–41.

    Article  PubMed  Google Scholar 

  45. Smyrniotis V, Kostopanagiotou G, Theodoraki K, Tsantoulas D, Contis JC. The role of central venous pressure and type of vascular control in blood loss during major liver resections. Am J Surg. 2004;187(3):398–402.

    Article  PubMed  Google Scholar 

  46. Miller CM, Schwartz ME, Nishizaki T. Combined hepatic and vena caval resection with autogenous caval graft replacement. Arch Surg. 1991;126(1):106–8.

    Article  CAS  PubMed  Google Scholar 

  47. Peschaud F, Laforest A, Allard MA, El Hajjam M, Nordlinger B. Can the left hepatic vein always be safely selectively clamped during hepatectomy? The contribution of anatomy. Surg Radiol Anat. 2009;31(9):657–63.

    Article  PubMed  Google Scholar 

  48. Rahbari NN, Koch M, Zimmermann JB, et al. Infrahepatic inferior vena cava clamping for reduction of central venous pressure and blood loss during hepatic resection: a randomized controlled trial. Ann Surg. 2011;253(6):1102–10.

    Article  PubMed  Google Scholar 

  49. Schnitzbauer AA, Lang SA, Goessmann H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg. 2012;255(3):405–14.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Monica Terlizzo, M.D., a Consultant Histopathologist at Aintree University Hospital for reviewing the histological slides, and Pete Groom, FRCA, a Consultant Anesthetist, for his support and review of the anesthetic section.

Conflict of interest

The authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of General and Hepatobiliary Surgery, University Hospital Aintree, Longmoore Lane, Liverpool, L9 7AL, UK

    Stefan Stättner, Vincent Yip, Robert P. Jones, Stephen W. Fenwick, Graeme J. Poston & Hassan Malik

  2. Department of Surgery, Paracelsus Private Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria

    Stefan Stättner

  3. Department of Anesthesia, University Hospital Aintree, Longmoore Lane, Liverpool, L9 7AL, UK

    Carmen Lacasia

  4. School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool, UK

    Robert P. Jones

Authors
  1. Stefan Stättner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vincent Yip
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert P. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carmen Lacasia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stephen W. Fenwick
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Graeme J. Poston
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hassan Malik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefan Stättner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stättner, S., Yip, V., Jones, R.P. et al. Liver resection with concomitant inferior vena cava resection: experiences without veno-venous bypass. Surg Today 44, 1063–1071 (2014). https://doi.org/10.1007/s00595-013-0652-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-013-0652-z

Keywords

Search

Navigation