Abstract
Vascular surgery in liver resection is a standard part of liver transplantation, but is also used in oncological liver surgery. Malignant liver tumors with vascular involvement have a poor prognosis without resection. Surgery is currently the only treatment to provide long-term survival in advanced hepatic malignancy. Even though extended liver resections are increasingly performed, vascular involvement with need of vascular reconstruction is still considered a contraindication for surgery in many institutions. However, vascular resection and reconstruction in liver surgery—despite being complex procedures—are safely performed in specialized centers. The improvements of the postoperative results with reduced postoperative morbidity and mortality are a result of rising surgical and anesthesiological experience and advancements in multimodal treatment concepts with preconditioning measures regarding liver function and systemic treatment options. This review focuses on vascular surgery in oncological liver resections. Even though many surgical techniques were developed and are also used during liver transplantation, this special procedure is not particularly covered within this review article. We provide a summary of vascular reconstruction techniques in oncological liver surgery according to the literature and present also our own experience. We aim to outline the current advances and standards in extended surgical procedures for liver tumors with vascular involvement established in specialized centers, since curative resection improves long-term survival and shifts palliative concepts to curative therapy.
Highlights
Surgery is the only curative treatment for primary and secondary liver malignancies providing the best chances of cure and the lowest local recurrence rates compared to other treatment modalities
One reason is the concern of a dismal prognosis, the other reason is the concern regarding technical resectability if several vessels are infiltrated by the tumor
This review aims to show up a summary of surgical standard techniques of vascular surgery in liver resections
Summary
Surgery is the only curative treatment for primary and secondary liver malignancies providing the best chances of cure and the lowest local recurrence rates compared to other (local) treatment modalities. Vascular invasion is often considered a contraindication for hepatic surgery in many institutions leading to palliative concepts for the affected patients. The primary goal in oncological surgery is the achievement of complete tumor clearance while maintaining patient safety. Vascular resection and reconstruction are standard procedures in liver transplantation for more than 50 years and those techniques improved constantly since the first liver. Vascular reconstruction in oncological liver resections is often much more demanding because the vessels to be reconstructed are smaller and mostly located intrahepatically with difficult surgical access [2]. A combination of loss of liver parenchyma with associated perioperative risks such as postoperative liver failure due to a small liver remnant and vascular reconstruction lead many surgeons to abandon resection in such advanced cases
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