Hepatic vein management in a parenchyma-sparing policy for resecting colorectal liver metastases at the caval confluence

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Abstract

Background: Patients with tumors involving hepatic vein at the caval-confluence usually receive major hepatectomies or hepatic vein grafting; however, nonnegligible postoperative mortality and morbidity are associated. Authors introduced the tumor-vessel detachment for colorectal liver metastases. Then we reviewed our results applying this approach in patients with colorectal liver metastases in contact with hepatic veins at the caval-confluence. Methods: A cohort of consecutive patients with colorectal liver metastases in contact with hepatic veins at the caval-confluence undergoing liver surgery was reviewed. Relationships were classified as: Type 1: contact/involvement less than a third of hepatic vein circumference; Type 2: contact/involvement in a third to two-thirds; Type 3: contact/involvement in more than two-thirds. Hepatic vein- colorectal liver metastases detachment, or in case of hepatic vein-resection, the sparing of the drained parenchyma, were attempted systematically. Results: Overall 190 colorectal liver metastases-hepatic vein contacts in 135 patients were analyzed. Colorectal liver metastases-hepatic vein detachment was performed in 95 (50%) contacts, partial resection and direct suture in 61 (32%), partial resection and patching in 4 (2%), and hepatic vein complete resection in 30 (16%). Hepatic vein-sparing resection was possible in 102 patients (76%), and major hepatectomy was needed in 1 (0.7%). Operative mortality, overall and major morbidity rate were 0.7%, 32%, and 4%, respectively. Local recurrence rate was 6% (median follow-up: 27 months). Preoperative and intraoperative imaging predicted the need for hepatic vein resection in 99% of patients (κ = 0.971). Conclusions: Hepatic vein-sparing or a parenchyma-sparing policy is feasible in most patients with colorectal liver metastases-hepatic vein contacts at the caval-confluence. This approach seems safe, predictable, and oncologically adequate, and, upon further confirmation, could become an alternative to major hepatectomies or hepatic vein replacement. (Surgery 2017;160:XXX-XXX.).

Original languageEnglish
JournalSurgery (United States)
DOIs
Publication statusAccepted/In press - Jan 1 2017

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Venae Cavae
Hepatic Veins
Neoplasm Metastasis
Liver
Hepatectomy
Morbidity
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

@article{d899c39772574f258f25c0acd1d8423c,
title = "Hepatic vein management in a parenchyma-sparing policy for resecting colorectal liver metastases at the caval confluence",
abstract = "Background: Patients with tumors involving hepatic vein at the caval-confluence usually receive major hepatectomies or hepatic vein grafting; however, nonnegligible postoperative mortality and morbidity are associated. Authors introduced the tumor-vessel detachment for colorectal liver metastases. Then we reviewed our results applying this approach in patients with colorectal liver metastases in contact with hepatic veins at the caval-confluence. Methods: A cohort of consecutive patients with colorectal liver metastases in contact with hepatic veins at the caval-confluence undergoing liver surgery was reviewed. Relationships were classified as: Type 1: contact/involvement less than a third of hepatic vein circumference; Type 2: contact/involvement in a third to two-thirds; Type 3: contact/involvement in more than two-thirds. Hepatic vein- colorectal liver metastases detachment, or in case of hepatic vein-resection, the sparing of the drained parenchyma, were attempted systematically. Results: Overall 190 colorectal liver metastases-hepatic vein contacts in 135 patients were analyzed. Colorectal liver metastases-hepatic vein detachment was performed in 95 (50{\%}) contacts, partial resection and direct suture in 61 (32{\%}), partial resection and patching in 4 (2{\%}), and hepatic vein complete resection in 30 (16{\%}). Hepatic vein-sparing resection was possible in 102 patients (76{\%}), and major hepatectomy was needed in 1 (0.7{\%}). Operative mortality, overall and major morbidity rate were 0.7{\%}, 32{\%}, and 4{\%}, respectively. Local recurrence rate was 6{\%} (median follow-up: 27 months). Preoperative and intraoperative imaging predicted the need for hepatic vein resection in 99{\%} of patients (κ = 0.971). Conclusions: Hepatic vein-sparing or a parenchyma-sparing policy is feasible in most patients with colorectal liver metastases-hepatic vein contacts at the caval-confluence. This approach seems safe, predictable, and oncologically adequate, and, upon further confirmation, could become an alternative to major hepatectomies or hepatic vein replacement. (Surgery 2017;160:XXX-XXX.).",
author = "Guido Torzilli and Fabio Procopio and Luca Vigan{\`o} and Matteo Cimino and Guido Costa and {Del Fabbro}, Daniele and Matteo Donadon",
year = "2017",
month = "1",
day = "1",
doi = "10.1016/j.surg.2017.09.003",
language = "English",
journal = "Surgery",
issn = "0039-6060",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Hepatic vein management in a parenchyma-sparing policy for resecting colorectal liver metastases at the caval confluence

AU - Torzilli, Guido

AU - Procopio, Fabio

AU - Viganò, Luca

AU - Cimino, Matteo

AU - Costa, Guido

AU - Del Fabbro, Daniele

AU - Donadon, Matteo

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background: Patients with tumors involving hepatic vein at the caval-confluence usually receive major hepatectomies or hepatic vein grafting; however, nonnegligible postoperative mortality and morbidity are associated. Authors introduced the tumor-vessel detachment for colorectal liver metastases. Then we reviewed our results applying this approach in patients with colorectal liver metastases in contact with hepatic veins at the caval-confluence. Methods: A cohort of consecutive patients with colorectal liver metastases in contact with hepatic veins at the caval-confluence undergoing liver surgery was reviewed. Relationships were classified as: Type 1: contact/involvement less than a third of hepatic vein circumference; Type 2: contact/involvement in a third to two-thirds; Type 3: contact/involvement in more than two-thirds. Hepatic vein- colorectal liver metastases detachment, or in case of hepatic vein-resection, the sparing of the drained parenchyma, were attempted systematically. Results: Overall 190 colorectal liver metastases-hepatic vein contacts in 135 patients were analyzed. Colorectal liver metastases-hepatic vein detachment was performed in 95 (50%) contacts, partial resection and direct suture in 61 (32%), partial resection and patching in 4 (2%), and hepatic vein complete resection in 30 (16%). Hepatic vein-sparing resection was possible in 102 patients (76%), and major hepatectomy was needed in 1 (0.7%). Operative mortality, overall and major morbidity rate were 0.7%, 32%, and 4%, respectively. Local recurrence rate was 6% (median follow-up: 27 months). Preoperative and intraoperative imaging predicted the need for hepatic vein resection in 99% of patients (κ = 0.971). Conclusions: Hepatic vein-sparing or a parenchyma-sparing policy is feasible in most patients with colorectal liver metastases-hepatic vein contacts at the caval-confluence. This approach seems safe, predictable, and oncologically adequate, and, upon further confirmation, could become an alternative to major hepatectomies or hepatic vein replacement. (Surgery 2017;160:XXX-XXX.).

AB - Background: Patients with tumors involving hepatic vein at the caval-confluence usually receive major hepatectomies or hepatic vein grafting; however, nonnegligible postoperative mortality and morbidity are associated. Authors introduced the tumor-vessel detachment for colorectal liver metastases. Then we reviewed our results applying this approach in patients with colorectal liver metastases in contact with hepatic veins at the caval-confluence. Methods: A cohort of consecutive patients with colorectal liver metastases in contact with hepatic veins at the caval-confluence undergoing liver surgery was reviewed. Relationships were classified as: Type 1: contact/involvement less than a third of hepatic vein circumference; Type 2: contact/involvement in a third to two-thirds; Type 3: contact/involvement in more than two-thirds. Hepatic vein- colorectal liver metastases detachment, or in case of hepatic vein-resection, the sparing of the drained parenchyma, were attempted systematically. Results: Overall 190 colorectal liver metastases-hepatic vein contacts in 135 patients were analyzed. Colorectal liver metastases-hepatic vein detachment was performed in 95 (50%) contacts, partial resection and direct suture in 61 (32%), partial resection and patching in 4 (2%), and hepatic vein complete resection in 30 (16%). Hepatic vein-sparing resection was possible in 102 patients (76%), and major hepatectomy was needed in 1 (0.7%). Operative mortality, overall and major morbidity rate were 0.7%, 32%, and 4%, respectively. Local recurrence rate was 6% (median follow-up: 27 months). Preoperative and intraoperative imaging predicted the need for hepatic vein resection in 99% of patients (κ = 0.971). Conclusions: Hepatic vein-sparing or a parenchyma-sparing policy is feasible in most patients with colorectal liver metastases-hepatic vein contacts at the caval-confluence. This approach seems safe, predictable, and oncologically adequate, and, upon further confirmation, could become an alternative to major hepatectomies or hepatic vein replacement. (Surgery 2017;160:XXX-XXX.).

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U2 - 10.1016/j.surg.2017.09.003

DO - 10.1016/j.surg.2017.09.003

M3 - Article

C2 - 29169612

AN - SCOPUS:85034668506

JO - Surgery

JF - Surgery

SN - 0039-6060

ER -