Hepatic resection with reconstruction of the inferior vena cava or hepatic venous confluence for metastatic liver tumor from colorectal cancer.
BACKGROUND
Resection of colorectal liver metastases infiltrating the inferior vena cava (IVC) or hepatic venous confluence (HVC) is technically feasible, but the procedure frequently involves invasive techniques, and its long-term outcome has not yet been fully described.


METHODS
From October 1994 through June 2001, 87 patients underwent first curative hepatic resections for colorectal metastases. Nine patients (the IVC/HVC group) received hepatectomy combined with IVC or HVC reconstruction. Clinicopathologic characteristics, surgical results, and patient survival were investigated and compared with those of the remaining 78 patients (the comparison group).


RESULTS
Three IVCs and eight hepatic veins were successfully resected and reconstructed by primary closure (n = 3), direct anastomosis (n = 1), or by the use of autologous vein grafts (n = 7). A comparison between the two groups revealed that the primary colorectal tumor stage was similar, but the IVC/HVC group had more (median 4 versus 2, p < 0.05) and larger (median 5.0 versus 3.2 cm, p < 0.05) lesions. The IVC/HVC group required longer operating times (median 600 versus 320 minutes, p < 0.001) and suffered greater blood loss (median 1,034 versus 434 g, p < 0.01) and more extensive liver parenchyma resection (median 585 versus 155 g, p < 0.001). Patients in the IVC/HVC group had a shorter survival time (median survival time 25.8 versus 44.0 months, p < 0.01).


CONCLUSIONS
Hepatic resection combined with the IVC or HVC reconstruction for colorectal liver metastases can be performed with acceptable morbidity, and possibly with no mortality. Although no definite conclusion on long-term survival can be drawn from our study, given the limited number of patients, their overall survival was unsatisfactory. Further studies are needed to clarify the contribution of combined resection and reconstruction of IVC/HVC to long-term survival, because surgical resection currently provides the only hope of cure.
Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Taku
T
Aoki
Yasuhiko
Y
Sugawara
Hiroshi
H
Imamura
Yasuji
Y
Seyama
Masami
M
Minagawa
Kiyoshi
K
Hasegawa
Norihiro
N
Kokudo
Masatoshi
M
Makuuchi
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality; D012086:Reoperation / Q000401:mortality; D015996:Survival Rate; D014680:Veins / Q000637:transplantation; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*