Combined liver and inferior vena cava resection with reconstruction using artificial vascular graft for liver tumors

Abstract

Introduction: In cases with liver tumors accompanied with inferior IVC invasion, IVC resection is sometimes required as a chance for cure with liver resection. Furthermore, IVC reconstruction with artificial vascular graft is also needed after the resection when area of defect after the IVC resection is large. There have been few reports of cases with IVC reconstruction using the graft. Methods: The study included 12 cases undergoing liver resection with IVC resection and subsequent reconstruction using artificial vascular graft. Surgical outcome of the cases were investigated. Results: The resected liver tumor was intrahepatic cholangiocarcinoma in four cases, metastatic liver tumor from colorectal cancer in three, liver sarcoma in two, adrenal cancer in one, malignant lymphoma in one, and inflammatory pseudotumor in one. IVC resection and reconstruction was performed under IVC clamp with remnant liver perfusion in six cases, and under THVE in six cases. ePTFE graft was used for IVC patch in one case and for replacement of the entire circumference of IVC in 11 cases Median operative time was 650 min. (range; 360 to 1050 min.) and blood loss was 2600 mL (range; 1196 to 8030 mL). Postoperative complication developed in two patients; bleeding in one and bile leakage in the other one. There were no operative mortality cases. During postoperative follow-up period, no complications associated with the graft were observed and the grafts remained patent in all the cases. Conclusion: These results suggested favorable outcome of liver resection with IVC resection and reconstruction using artificial vascular graft.