SURGICAL MANAGEMENT OF COLORECTAL LIVER METASTASES WITH MAJOR VESSEL INVOLVEMENT
Janine Baumgart*, Sebastian Hiller, Michael Kloth, Hauke Lang
General, Visceral and Transplantation Surgery, Universitatsmedizin der Johannes Gutenberg-Universitat Mainz, Mainz, Rheinland-Pfalz, Germany
Background: Treatment of colorectal liver metastases (CRLM) with major vessel involvement is still challenging and valid data on outcome are lacking. The aim of this study was to analyse our institutional experience of hepatectomies in combination with resection/reconstruction of major hepatic vessels with regard to surgical approaches and outcome.
Methods: Data of 32 combined hepatectomies with major hepatic vessel resections/reconstructions were included. Results were correlated with perioperative and oncological outcome.
Results: The vena cava inferior (VCI) alone was resected and reconstructed in 17, the portal vein (PV) in 6 and a hepatic vein (HV) in 10 cases. One patient received a combined resection and reconstruction of the VCI and the PV and another of the VCI and a HV. Histopathological examination confirmed an infiltration of the vascular structures in 6 patients (18.75%). The VCI was affected in 3/17 patients, a HV in 2/10 patients and the PV in 1/6 patient. There were 27 R0- and 5 R1-resections. All R1-situations were at the parenchymal margin. In-hospital mortality was 0, respectively. The overall survival (OS) was 33.3 months (COI 22.1 – 44.4 months).
Conclusion: Liver resection with vascular resection/reconstruction is a safe and feasible surgical approach. Our preferred intention-to-treat concept in these cases is parenchymal sparing liver resection with vascular resection and reconstruction to achieve a negative margin. In technically difficult cases with supposed higher risk for postoperative complications tumor detachment from vessels without vascular resection and achievement of a R1 vascular situation is a most reasonable surgical alternative.
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