Hepatic Vein (HV) Reconstruction (HVR) for Liver Tumors Involving Hepatocaval Confluence (HCO) Is Safe and Feasible to Achieve R0 Resection

Roumain, M.;Marique, Lancelot;Hubert, C.;Coubeau, Laurent
(2023) HPB : the official journal of the International Hepato Pancreato Biliary Association — Vol. 25, p. S366 (2023)

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Authors
  • Roumain, M.UCLouvain
    Author
  • Marique, LancelotUCLouvain
    Author
  • Hubert, C.UCLouvain
    Author
  • Coubeau, LaurentUCLouvain
    Author
Abstract
Purpose: Surgical resection remains the cornerstone treatment for liver tumors. Local recurrence risk is determined by surgery radicality which forces significant parenchymal sacrifice or R1 resection in case of vascular involvement. Jump-graft between intra-parenchymal origin and superior stump HVR might be necessary to preserve remnant liver adequate outflow when radical surgery requires a resection at HCo. Methods: Monocentric retrospective analysis of intraoperative data and outcomes in 16patients who underwent HVR(2018-2021) was performed. After tumor dissection under ultrasound control, proximal and distal HV stumps were clamped and involved hepatocaval segment resected in single block. Reconstruction was performed by interposition of vascular graft between both stumps. Results: Patients presented with different conditions: liver metastasis (n=13), intrahepatic cholangiocarcinoma (n=1), hepatocellular carcinoma (n=2). Non-frozen ABO-compatible venous homograft (n=12), autologous peritoneal patch/tube (n=3), autologous veins (n=1) were used as jump-grafts. Median HV clamping duration was 63min(54-90min). Pedicular clamping was only performed when HVR was associated to IVC replacement(n=2). Double HVR was also performed (n=3). HVR patency at day7 was 94%(15/16), at 3months 81%(13/16). Median blood loss was 1100ml(837-1700ml), R0 resection was achieved in 13/16(81%). Severe morbidity (Clavien III-IV) reached 25%(4/16). Small for size syndrome was null. Day90 mortality was null. Conclusion: In our series, R0 resection rate was high as well as early and late graft patency. Morbi-mortality was acceptable. HVR technique allows replacement of a single or double HV without significant bleeding nor need for pedicle clamping (if not associated to IVC replacement). Therefore, HVR should be considered as a realistic option in parenchymal-sparing strategy or radical surgery.
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Roumain, M., Marique, L., Hubert, C., & Coubeau, L. (2023). Hepatic Vein (HV) Reconstruction (HVR) for Liver Tumors Involving Hepatocaval Confluence (HCO) Is Safe and Feasible to Achieve R0 Resection. HPB : the official journal of the International Hepato Pancreato Biliary Association, 25, S366. https://doi.org/10.1016/j.hpb.2023.07.353 (Original work published 2023)