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Surgical Outcome of Hepatic Vein Reconstruction Using an External Iliac Vein Graft
Fumihiro Terasaki*, Yuji Kaneoka, Atsuyuki Maeda, Yuichi Takayama
Ogaki Municipal Hospital, Ogaki, Japan
Backgrounds. A liver tumor invading to hepatic vein is difficult to resect because of its anatomical situation and in the patients with liver dysfunction. The extent of liver resection is crucial in relation to parenchymal preservation with hepatic vein reconstruction. In cirrhosis or decreased liver function, major hepatectomy is critical and sometimes a palliative liver resection is chosen, however, we performed in such cases preparatory hepatic subsegmentectomy combined with hepatic vein resection and reconstruction (HVR) for achieving negative surgical margin and preserving the remnant liver function. We investigated surgical outcome of the consecutive 17 cases of hepatectomy with HVR.
Methods. Between August 1996 and October 2014, we performed 17 cases of hepatectomy with HVR including 11 hepatocellular carcinomas and 6 metastatic tumors from colorectum. 13 cases underwent segments VII/VIII resection and right hepatic vein (RHV) reconstruction, 3 cases underwent segment II resection and left hepatic vein (LHV) reconstruction, and 1 case underwent segments I/IV resection and middle hepatic vein (MHV) reconstruction. Before HVR, an external iliac vein graft is picked up extraperitoneally through upper groin incision. In HVR, we sustain hepatic vein and the graft at 4 points by suturing them with 6-0 prolene and afterwards we use Vascular Clips (M-sized, Coviden) 4-5 times between each stich.
Results. Mean age of the subjects was 66.4 y.o. (range, 53 to 79), and male/female ratio was 14/3. The Operating times were 155 to 400 minutes (mean 277±72 minutes), and the mean hepatic vein reconstruction time was 27±5 minutes (range, 19 to 40). The length of the graft was 2 to 4 cm. In 2 cases out of 17 cases, we experienced occlusion of the graft 2 weeks after surgery, however, the patients' condition was stable and they discharged. Another one patient who had received the right lobectomy underwent segment IV and LHV reconstruction revealed the early obstruction of the graft and an emergency surgery was needed. Patency of the graft was 14/17 (82%). Morbidity (Clavien-Dindo>III) was 4/17 (23.5%), which included 1 infarction, 1 hepatic coma, 1 bile leakage and 1 duodenal ulcer. Mortality was null.
Conclusion. Preparatory hepatic resection with HVR could be carried out safely to the patients with decreased liver function or small residual liver parenchyma.
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