Suspected major vessel involvement in patients with colorectal liver metastases (CRLM): Single Center Experience of 13 Cases

Abstract

Background: The role of major vessel involvement in the treatment of CRLM still remains unclear. Methods: From Jan. 2008 to Oct. 2016, 650 liver resections (LR)for CRLM were performed.13 cases included resection of major vessel with reconstruction because of suspect tumor infiltration. The portal vein (PV) was resected in 2 and the inferior vena cava (IVC) in 10 cases. Combined resection and reconstruction of the PV and IVC was performed in 1 case. Results: All PV-patients (n=2) received a segmental resection. PV resection was combined with 2 major LR.Regarding the IVC, tangential resection was performed in all cases (n=10). Minor and major LR were accomplished in 5 cases each. The patient with combined vessel resection received a segmental resection of the PV and a tangential resection of the IVC. Median hospital stay was 17d and major postoperative complications Grade III-IV, occurred in 3 patients. In-hospital-mortality was 0%.R0-resection was achieved in all cases. Histopathological examinations approved in each group 1 case of microscopic invasion. The patient with invasion of the IVC is still alive, receiving chemotherapy because of intrahepatic recurrence. The patient with invasion of the PV died after 33 months. Conclusion: Microvascular invasion is a rare event in CRLM (2 of 650 liver resections). Even in cases of macroscopic radiological adherence, microscopic invasion was rarely observed in 15%. Therefore, radiologic diagnosis of CRLM adjacent to major vessels is not a contraindication for surgery.