Hepatic malignancies infiltrating the hepatocaval confluence - A single center experience with ante situm liver resection

Abstract

Background: The ante situm-technique allows for luxation of the liver in front of the situs, enabling the experienced HPB-surgeon to resect liver malignancies invading the hepatic veins/inferior vena cava. Single-center experience with ante-situm liver resection over the past 10 years is presented. Methods: Retrospective analysis on patients receiving ante situm liver resection comprising demographical and basic clinical data as well as perioperative courses. Results: Ante situm liver resection was performed on 7 patients suffering from primary (n=5) or secondary (n=2) liver tumors. Patients received trisegmentectomy (n=4), extended left hemihepatectomy (n=1) or atypical liver resection (segments 8/4a; n=2) combined with dissection of the suprahepatic vena cava/liver veins. Venous reconstruction was performed as reinsertion of liver veins (n=3) or vascular replacement with allogeneic donor veins (n=3) or PTFE-graft (n=1) in total vascular occlusion (mean of 29.6 min.). Severe morbidity defined as Dindo Clavien >3a was found in 3 patients; one patient died due to small-for-size syndrome. Mean length of stay at ICU and hospital were 9.0 and 34.3 days, respectively. R0-resection was achieved in 5 cases (twice a R1-situation). Disease-free survival was 24.6 months with an overall survival of 34.4 months. Conclusion: Ante situm liver resection offers the opportunity to achieve surgical cure in otherwise unresectable tumors. Nevertheless, this approach remains challenging with need for complex vascular reconstruction.