Surgical Outcomes of Hepatectomy with Vascular Resection for Colorectal Liver Metastases

Abstract

Introduction: Liver resection combined with vascular reconstruction is a curative option for hepatic metastases with vascular invasion. However, vascular surgery during major liver resection significantly increases morbidity and mortality. This study aims to assess the results of vascular resection and reconstruction during hepatectomy for colorectal liver metastases (CLM). Methods: We conducted a descriptive study to evaluate surgical outcomes of CLM patients who underwent hepatectomy with vascular resection. A prospectively collected database was reviewed from January 2019 to May 2021. Results: Overall, 10 hepatectomies in 9 CLM patients were included in the study (3 female and 6 male). The median age was 57 (IQR: 53-61) years. Performed procedures included 4 right hepatectomies, 2 right extended hepatectomies, 2 left extended hepatectomies, 1 central hepatectomy, and 1 segmentectomy of 4B liver segment. Vascular surgery involved 3 portal vein resections, 6 hepatic vein resections, and 1 simultaneous portal vein and hepatic artery resection. Median total liver ischemia time was 50 (IQR: 21-84) min. Median operative time was 375 (IQR: 225-585) min. Median blood loss was 900 (IQR: 250-2000) mL and 4 patients (40%) required blood transfusions. R0 rate was 90%. The 90-day major morbidity (Clavien-Dindo grade III-V) and mortality were 80% and 33%. Median ICU and hospital stays were 3 (IQR: 1-5) and 18 (IQR: 9-33) days. Conclusion: Hepatectomy with vascular resection is feasible for CLM with vascular invasion and demonstrates outcomes comparable with available data from high-volume centers.Tabled 1EP01C-017No.SexAge (years)Type of hepatectomyType of VRLiver ischemia time (min)Operating time (min)Blood loss (mL)Morbidity (CD grade)Death cause1M55RHLPV756701,500IIIbNA2M59CHLHV110350800IIIaNA3F61LEHRHV21290600Vsmall-for-size syndrome4M53REHRHV844003,500IIIaNA5F49RHMHV30200250IIIbNA6F72RHPVC15225250INA7F72SMHV20180100INA8M52REHLHA, PV605854,000Vmassive bleeding9M57LEHLHV, MHV1076602,000Vliver failure10M57RHPV404101,000IIIbNABMI, body mass index; CD, Clavien-Dindo; CH central hepatectomy; F, female; LEH, left extended hepatectomy; LHA, left hepatic artery; LHV, left hepatic vein; LPV, left portal vein; M, male; MHV, middle hepatic vein; NA, not applicable; OR, operating room; PV, portal vein; PVC, portal vein confluence; REH, right extended hepatectomy; RH, right hepatectomy; RHV, right hepatic vein; S, segmentectomy; VR, vascular resection and reconstruction Open table in a new tab BMI, body mass index; CD, Clavien-Dindo; CH central hepatectomy; F, female; LEH, left extended hepatectomy; LHA, left hepatic artery; LHV, left hepatic vein; LPV, left portal vein; M, male; MHV, middle hepatic vein; NA, not applicable; OR, operating room; PV, portal vein; PVC, portal vein confluence; REH, right extended hepatectomy; RH, right hepatectomy; RHV, right hepatic vein; S, segmentectomy; VR, vascular resection and reconstruction