Combined Vascular Resections

Abstract

As radical surgery has become suitable for more patients with colorectal liver metastasis thanks to development of effective chemotherapy, the technique of a combined hepatic vascular resection has been more important. The vasculature adjoining a colorectal liver metastasis should often be resected with the tumor because of the nature showing infiltrative growth. When the intrahepatic portal branch or the major hepatic vein should be resected and sacrificed, a preoperative calculation of the hepatic volume influenced by the vasculature is necessary for safe hepatic resection. There are various technical issues for the combined resection of the hilar portal vein, the hepatic vein, and the vena cava. The methods for resecting a vasculature include a wedge resection and a circumferential segmental resection. Reconstruction methods after segmental resection include a direct end-to-end anastomosis and a reconstruction using an interposed graft. Reconstruction methods after wedge resection include a primary closure and a patch repair.