Successful use of the left portal vein as graft for middle hepatic vein reconstruction in left hemihepatectomy: preliminary experience on six cases

World Journal of Surgical Oncology - Tập 17 - Trang 1-5 - 2019
Tao Lv1, Ling Xiang Kong1, Jiayin Yang1, Hong Wu1, Tianfu Wen1, Li Jiang1, Jian Yang1
1Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China

Tóm tắt

The purpose of this research was to assess the feasibility of reconstructing the middle hepatic vein (MHV) with resected left portal vein during left hemihepatectomy. From January 2014 to January 2018, six patients received left hemihepatectomy combined with MHV reconstruction using the resected left portal vein in West China Hospital. We reviewed the clinical data including patient details, surgical technique, graft patency, and operative results. All six patients underwent left hemihepatectomy for liver tumors located at left hepatocaval confluence. In these patients, MHV was resected due to tumor invading and reconstructed using the resected left portal vein as graft. The mean operating time was 316 min. Two patients developed complications: one experienced bile leakage and one experienced pleural effusion. No patient developed vascular graft complications. All the grafts remained unobstructed, and no local tumor recurrence occurred during the observation period of 13–41 months. Our results indicated that the left portal vein was a safe graft for hepatic vein reconstruction. In addition, left hemihepatectomy combined with middle hepatic vein resection and reconstruction using the left portal vein can be performed safely to treat liver tumors located at hepatocaval confluence.

Tài liệu tham khảo

Orimo T, et al. Usefulness of artificial vascular graft for venous reconstruction in liver surgery. World J Surg Oncol. 2014;12:113. Sakamoto Y, et al. Reconstruction of hepatic or portal veins by use of newly customized great saphenous vein grafts. Langenbeck's Arch Surg. 2004;389(2):110–3. di Francesco F, et al. Pre-duodenal portal vein reconstruction at liver transplantation: the challenges and a solution. Liver Transpl. 2019;9:1. Kaneoka Y, et al. Hepatic vein reconstruction by external iliac vein graft using vascular clips. World J Surg. 2000;24(3):377–82. Hirono S, et al. Indication for the use of an interposed graft during portal vein and/or superior mesenteric vein reconstruction in pancreatic resection based on perioperative outcomes. Langenbeck's Arch Surg. 2014;399(4):461–71. Stuben BO, et al. Successful use of the recanalized remnant umbilical vein as a patch graft for venous reconstruction in abdominal surgery. J Gastrointest Surg. 2019;23(6):1227–31. Yamamoto M, et al. Safety and efficacy of venous reconstruction in liver resection using cryopreserved homologous veins. J Hepatobiliary Pancreat Sci. 2017;24(9):511–9. Qi X, et al. Management of hepatocellular carcinoma: an overview of major findings from meta-analyses. Oncotarget. 2016;7(23):34703–51. Mise Y, et al. How has virtual hepatectomy changed the practice of liver surgery? Experience of 1194 virtual hepatectomy before liver resection and living donor liver transplantation. Ann Surg. 2018;268(1):127–33. Li W, Wu H, Han J. Surgical outcomes of hepatocellular carcinoma invading hepatocaval confluence. Hepatobiliary Pancreat Dis Int. 2016;15(6):593–601. Mekeel KL, Hemming AW. Evolving role of vascular resection and reconstruction in hepatic surgery for malignancy. Hepat Oncol. 2014;1(1):53–65. Mise Y, et al. Venous reconstruction based on virtual liver resection to avoid congestion in the liver remnant. Br J Surg. 2011;98(12):1742–51. Tani K, et al. Venous drainage map of the liver for complex hepatobiliary surgery and liver transplantation. HPB (Oxford). 2016;18(12):1031–8. Kawamoto Y, Ome Y, Kawamoto K. Partial hepatectomy with middle hepatic vein reconstruction using a left inferior vena cava graft. Case Rep Gastroenterol. 2017;11(2):320–8. Surjan RC, et al. A novel technique for hepatic vein reconstruction during hepatectomy. J Surg Case Rep. 2016;2016(4):1–4.