Hepatobiliary resection with inferior vena cava resection and reconstruction using an autologous patch graft for intrahepatic cholangiocarcinoma.
BACKGROUND
In patients with advanced cholangiocarcinoma involving the inferior vena cava (IVC), an extended hepatobiliary resection with combined resection and reconstruction of the IVC is often prerequisite to obtain a clear resection margin.


METHODS
We present our approach to repair of approximately half of a cross-sectional wall defect of the IVC using an autologous external iliac venous patch graft during extended hepatobiliary resection with a total hepatic vascular exclusion technique. The harvested external iliac vein graft was incised longitudinally and trimmed to fit the IVC defect. After multiple stay sutures, a continuous running suture using 4-0 prolene was made.


RESULTS
Two patients who underwent this complex surgery survive 20 and 27 months after surgery, respectively. Morbidity of transient edema of the ipsilateral lower leg potentially related to graft harvesting was noted in one patient after surgery.


CONCLUSIONS
The external iliac vein patch graft for IVC resection and reconstruction during hepatobiliary resection is technically simple, produces no stenosis or caliber change in the reconstructed IVC, and is applicable for at least half or less of a cross-sectional defect of the IVC wall to be reconstructed.
Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan. tsusano@aichi-cc.jp
Tsuyoshi
T
Sano
Kazuaki
K
Shimada
Satoshi
S
Nara
Minoru
M
Esaki
Yoshihiro
Y
Sakamoto
Tomoo
T
Kosuge
D000368:Aged; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D014680:Veins / Q000637:transplantation*; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*