title: [Vascular reconstruction in hepatic surgery].
abstract: BACKGROUND
  Due to their size or location liver tumors can infiltrate important vascular structures, which are essential for postoperative liver function.
  
  
  OBJECTIVE
  To present the technical possibilities and results of current concepts of vascular resection and reconstruction in liver surgery.
  
  
  METHODS
  A literature search of the Medline and Cochrane databases was performed regarding currently available studies on vascular resection and reconstruction in liver surgery.
  
  
  RESULTS
  Portal vein resections are routinely performed by many institutions and can be performed as an end-to-end anastomosis or graft interposition. This is the basis of the en bloc resection concept, especially for Klatskin tumors. Reconstruction of the inferior vena cava as well as the hepatic arteries is technically feasible and is increasingly being reported in smaller series. In particular, the resection of tumors near the hepatic veins may require total vascular exclusion for complete interruption of liver perfusion, which enables resection in the non-perfused liver and by this reduced blood loss. Furthermore, in situ cooling, ante situm and ex situ resections increase both technical resectability and the ischemic tolerance of the liver to more than 60 min. The majority of vascular reconstructions can be performed without a significant increase in morbidity; however, vascular tumor infiltration is associated with impaired long-term survival.
  
  
  CONCLUSIONS
  Based on the experience of transplantation surgery concepts for vascular reconstruction can be safely applied to liver surgery. These concepts contribute to increasing the resectability of liver tumors. Due to the often impaired prognosis of vascular tumor infiltration, the use of these concepts should be individually assessed by weighing the prognosis against the morbidity.
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstrasse 1, 55131, Mainz, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Heinrich
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstrasse 1, 55131, Mainz, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Baumgart
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstrasse 1, 55131, Mainz, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Mittler
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstrasse 1, 55131, Mainz, Deutschland. hauke.lang@unimedizin-mainz.de.
authors.forename: H
authors.initials: H
authors.lastname: Lang
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D006498:Hepatectomy / Q000379:methods; D006499:Hepatic Artery / Q000473:pathology / Q000601:surgery; D006503:Hepatic Veins / Q000473:pathology / Q000601:surgery; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D018285:Klatskin Tumor / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D008099:Liver / Q000098:blood supply*; D008113:Liver Neoplasms / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D009361:Neoplasm Invasiveness; D011169:Portal Vein / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D014656:Vascular Surgical Procedures / Q000379:methods*; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery
keywords: Ante situ resection; Ex situ resection; In situ cooling; Portal vein reconstruction; Vascular resection