Background: In patients with advanced cholangiocarcinoma involving the inferior vena cava (IVC), an extended hepatobiliary resection with combined resection and reconstruction of the IVC is often prerequisite to obtain a clear resection margin. Patients and
Methods: We present our approach to repair of approximately half of a cross-sectional wall defect of the IVC using an autologous external iliac venous patch graft during extended hepatobiliary resection with a total hepatic vascular exclusion technique. The harvested external iliac vein graft was incised longitudinally and trimmed to fit the IVC defect. After multiple stay sutures, a continuous running suture using 4-0 prolene was made.
Results: A 72-year-old woman underwent the complex surgery (left trisectionectomy with total caudate lobe resection) survives 28 months without recurrence sign of the tumor after surgery. Total operation time was 863 minutes and intraoperative blood loss was 2775 g. The patient was discharged on the 26th postoperative day.A 64-year-old man underwent the complex surgery (right trisectionectomy with total caudate lobe resection, portal vein sleeve resection and reconstruction) survives 21 months with lung metastasis after surgery. Total operation time was 780 minutes andintraoperative blood loss was 2110 g. Morbidity of transient edema of the ipsilateral lower leg potentially related to graft harvesting was noted in the latter patient after surgery, and thereafter no anticoagulant therapy was required. The patient was discharged on the 62nd postoperative day.
Conclusions: The external iliac vein patch graft for IVC resection and reconstruction during hepatobiliary resection is technically simple, produces no stenosis or caliber change in the reconstructed IVC, and is applicable for at least half or less of a cross-sectional defect of the IVC wall to be reconstructed.