Journal article
Resection of the Liver and Inferior Vena Cava for Hepatic Malignancy
Journal of the American College of Surgeons, Vol.217(1), pp.115-124
07/01/2013
DOI: 10.1016/j.jamcollsurg.2012.12.003
PMID: 23376028
Abstract
BACKGROUND: Involvement of the IVC has traditionally been considered a relative contraindication to resection for advanced tumors of the liver. Combined resection of the liver and IVC for malignancy can be performed safely and results in long-term survival in select patients.
STUDY DESIGN: Sixty patients undergoing hepatic and IVC resection by the primary author from 1996 to 2012 were reviewed. Median age was 52 years. Resections were carried out for cholangiocarcinoma (n = 26), hepatocellular carcinoma (n = 16), colorectal metastases (n = 13), gastrointestinal stromal tumor (n = 2), hepatoblastoma (n = 2), and squamous cell carcinoma (n = 1). Resections performed included 27 right and 5 left trisegmentectomies and 25 right and 3 left lobectomies, including the caudate lobe. Ex vivo procedures were performed in 6 patients using venoevenous bypass and the other 54 procedures were performed using varying degrees of vascular isolation. In situ cold perfusion of the liver was used in 8 patients. The IVC was reconstructed using a tube graft (n = 38) primarily (n = 8) or with patches (n = 14).
RESULTS: There were 5 perioperative deaths (8%). Three patients died of liver failure, 1 patient died of pulmonary hemorrhage, and 1 patient died of massive pulmonary embolism. Nine patients had evidence of postoperative liver failure that resolved with supportive management. Three patients required temporary dialysis. With a median follow-up of 31 months, 14 patients have died of recurrent malignancy between 22 and 44 months, and an additional 4 patients are alive with disease at 16 to 33 months. Actuarial 1- and 5-year survival rates were 89% and 35%, respectively.
CONCLUSIONS: Inferior vena cava involvement by malignancy does not obviate liver resection. The procedure's increased risk is balanced by the possible benefits, given the lack of alternative curative approaches. ((C) 2013 by the American College of Surgeons)
Details
- Title: Subtitle
- Resection of the Liver and Inferior Vena Cava for Hepatic Malignancy
- Creators
- Alan W. Hemming - University of California, San DiegoKristin L. Mekeel - University of California, San DiegoIvan Zendejas - University of California, San DiegoRobin D. Kim - University of California, San DiegoJason K. Sicklick - University of California, San DiegoAlan I. Reed - University of California, San Diego
- Resource Type
- Journal article
- Publication Details
- Journal of the American College of Surgeons, Vol.217(1), pp.115-124
- Publisher
- Elsevier
- DOI
- 10.1016/j.jamcollsurg.2012.12.003
- PMID
- 23376028
- ISSN
- 1072-7515
- eISSN
- 1879-1190
- Number of pages
- 10
- Grant note
- R21CA192072 / NATIONAL CANCER INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Cancer Institute (NCI)
- Language
- English
- Date published
- 07/01/2013
- Academic Unit
- Accounting; Surgery
- Record Identifier
- 9984322826102771
Metrics
23 Record Views