T. Ochiai1, D. Asano1, J. Yoshino1, S. Watanabe1, Y. Ishikawa1, N. Chiyonobu1, Y. Mizuno1, T. Sato1, H. Ueda1, Y. Iwao1, H. Ono1, Y. Mitsunori1, S. Matsumura1, D. Ban1, A. Kudo1, S. Tanaka2, M. Tanabe1 1Tokyo Medical And Dental University,Department Of Hepto-Biliary And Pancreatic Surgery,Bunkyo-ku, Tokyo, Japan 2Tokyo Medical And Dental University,Department Of Molecular Oncology,Bunkyo-ku, Tokyo, Japan
Introduction: The prognosis of patients who have liver cancer associated with inferior vena cava tumor thrombus (IVCTT) or inferior vena cava invasion (IVCI) is very poor, and effective treatment modalities are extremely limited. The objective of this study is to determine the efficacy of surgery and appropriate surgical procedures for liver malignancy with IVCTT or IVCI.
Methods: From January 2003 to December 2015, 19 patients with the liver malignancy (eight metastatic tumors, seven hepatocellular carcinomas, three intrahepatic cholangiocarcinomas and one mixed hepatocellular cholangiocarcinoma) underwent hepatectomy with concomitant IVC resection and reconstruction for eight IVCTT and eleven IVCI. We retrospectively analyzed surgical procedures and survival.
Results:Of the 19 patients, 2 underwent trisegmentectomy, 6 underwent bisegmentectomy, 5 underwent segmentectomy and 6 underwent partial hepatectomy. As IVC reconstruction, 13 underwent primary closure, 4 required 20-mm expansive polytetrafluoroethylene (ePTFE) graft and 2 required patch graft using round ligament and epicardium, respectively. During the IVC cross-clamping, 6 required infrarenal abdominal aortic cross-clamping without cardiopulmonary bypass or venous bypass, 3 required extracorporeal circulation assisting device to maintain stable hemodynamics. Median operation time was 515 minutes (range 256 to 918 minutes) and median intraoperative bleeding was 2353 ml (range 740 to 44000 ml). No hospital death was recognized. The median survival time of hepatocellular carcinoma was 27 months (range 4 to 89 months) and of colorectal liver metastases was 22 months (range 2 to 48 months). One out of 3 in intrahepatic cholangiocarcinoma is still alive 60 months after surgery.
Conclusion:Hepatic resection with IVC resection and reconstruction for liver tumors provided acceptable outcomes in 19 patients. Considering morphology of the tumor and intraoperative hemodynamics, appropriate surgical procedures should be selected.