Lucio Urbani1, Nicolò Roffi2, Stefano Signori2, Riccardo Balestri2, Piero Colombatto3, Gabriella Licitra4, Chiara Leoni4, Daniele Meiattini4, Roberto Moretto5, Chiara Cremolini5, Gianluca Masi5, Piero Boraschi6, Francesca Quilici7, Piero Buccianti2, Marco Puccini2. 1. General Surgery Unit, Azienda Ospedaliero-Universitaria PisanaOspedale Nuovo Santa Chiara, Cisanello, Via Paradisa, 2, 56124, Pisa, Italy. l.urbani@ao-pisa.toscana.it. 2. General Surgery Unit, Azienda Ospedaliero-Universitaria PisanaOspedale Nuovo Santa Chiara, Cisanello, Via Paradisa, 2, 56124, Pisa, Italy. 3. Hepatology Unit, Azienda Ospedaliero-Universitaria PisanaOspedale Nuovo Santa Chiara, Cisanello, Via Paradisa, 2, 56124, Pisa, Italy. 4. Anaesthesiology and Intensive Care Unit, Azienda Ospedaliero-Universitaria PisanaOspedale Nuovo Santa Chiara, Cisanello, Via Paradisa, 2, 56124, Pisa, Italy. 5. Oncology Unit, Azienda Ospedaliero-Universitaria PisanaOspedale Nuovo Santa Chiara, Cisanello, Via Paradisa, 2, 56124, Pisa, Italy. 6. Radiology Unit, Azienda Ospedaliero-Universitaria PisanaOspedale Nuovo Santa Chiara, Cisanello, Via Paradisa, 2, 56124, Pisa, Italy. 7. Pathology Unit, Azienda Ospedaliero-Universitaria PisanaOspedale Nuovo Santa Chiara, Cisanello, Via Paradisa, 2, 56124, Pisa, Italy.
Abstract
BACKGROUND: Repeated hepatectomies in the therapeutic route of patients with colorectal liver metastases (CRLM) may improve their long term survival. Hepatic vein (HV) resection and reconstruction allows parenchyma-sparing hepatectomy (PSH) and R0 resections for CRLM in contact with one HV. We aimed at verifying the feasibility of PSH with double HV resection and direct reconstruction for CRLM in contact with two HVs at the hepatocaval confluence. METHODS: Out of 106 consecutive PSH performed for CRLM deep-located in segments I-IVa-VII-VIII, four (3.7%) PSH were performed with resection of CRLM en bloc with two adjacent HVs which were both reconstructed with double direct HV anastomosis: 3 cases between right-HV and middle-HV and 1 case between middle-HV and left-HV. Two patients had previously undergone liver resection. Three patients had one single lesion and one had 5 CRLMs. RESULTS: Median size of CRLMs in contact with HVs was 25 mm (range 22-30 mm). At histological examination, all resections were R0 except one R1-vascular (detachment from glissonean pedicle): in all cases at least one HV and in 1 case both HVs were infiltrated by the tumor cells. After median follow-up of 18 (range 3.5-41.2) months, all HVs were patent. All patients were alive and in good general conditions, and 3 patients were disease free (one of them following a liver re-resection). One patient experienced a grade IIIa complication. Median hospital-stay was 11 (range 9-13) days. CONCLUSION: In patients with CRLMs involving two adjacent HVs at the hepatocaval confluence, liver resection with double HV resection and direct reconstruction is feasible and may be considered to guarantee oncological radicality (R0) and spare health parenchyma.
BACKGROUND: Repeated hepatectomies in the therapeutic route of patients with colorectal liver metastases (CRLM) may improve their long term survival. Hepatic vein (HV) resection and reconstruction allows parenchyma-sparing hepatectomy (PSH) and R0 resections for CRLM in contact with one HV. We aimed at verifying the feasibility of PSH with double HV resection and direct reconstruction for CRLM in contact with two HVs at the hepatocaval confluence. METHODS: Out of 106 consecutive PSH performed for CRLM deep-located in segments I-IVa-VII-VIII, four (3.7%) PSH were performed with resection of CRLM en bloc with two adjacent HVs which were both reconstructed with double direct HV anastomosis: 3 cases between right-HV and middle-HV and 1 case between middle-HV and left-HV. Two patients had previously undergone liver resection. Three patients had one single lesion and one had 5 CRLMs. RESULTS: Median size of CRLMs in contact with HVs was 25 mm (range 22-30 mm). At histological examination, all resections were R0 except one R1-vascular (detachment from glissonean pedicle): in all cases at least one HV and in 1 case both HVs were infiltrated by the tumor cells. After median follow-up of 18 (range 3.5-41.2) months, all HVs were patent. All patients were alive and in good general conditions, and 3 patients were disease free (one of them following a liver re-resection). One patient experienced a grade IIIa complication. Median hospital-stay was 11 (range 9-13) days. CONCLUSION: In patients with CRLMs involving two adjacent HVs at the hepatocaval confluence, liver resection with double HV resection and direct reconstruction is feasible and may be considered to guarantee oncological radicality (R0) and spare health parenchyma.
Authors: F Oldhafer; K I Ringe; K Timrott; M Kleine; O Beetz; W Ramackers; S Cammann; J Klempnauer; F W R Vondran; H Bektas Journal: Langenbecks Arch Surg Date: 2018-02-22 Impact factor: 3.445