title: Parenchyma-Sparing Hepatectomy with Vascular Reconstruction Techniques for Resection of Colorectal Liver Metastases with Major Vascular Invasion.
abstract: BACKGROUND
  Resectability of colorectal liver metastasis (CRLM) depends on major vascular involvement and is affected by chemotherapy-induced liver injury. Parenchyma-sparing with combined resection and reconstruction of involved vessels may expand the indications and safety of hepatectomy.
  
  
  METHODS
  Of 92 patients who underwent hepatectomy for CRLM, 15 underwent major vascular resection and reconstruction. The reconstructed vessels were the portal vein (PV) in five cases, the major hepatic vein (HV) in nine cases, and the inferior vena cava in six cases.
  
  
  RESULTS
  All PV reconstructions were direct anastomoses. The HV was reconstructed with an autologous inferior mesenteric venous patch or an external iliac vein interposition graft. Total hepatic vascular exclusion was performed for six patients. Of nine patients with HV reconstruction, three had tumors involving all three major HVs, in whom the left HV was reconstructed as an only vein after extended right hepatectomy. In another six patients, multiple bilobar tumors or tumors in the liver that had chemotherapy-induced injury involved one or two HVs. Parenchyma-sparing by reconstruction of the HV was performed to secure the residual liver function. The patients with vascular reconstruction had an operative time of 462 ± 111 min and a blood loss of 1278 ± 528 mL. No complication classified as Clavien-Dindo 3 or more developed. The median hospital stay was 17 days (range 8-26 days). The cumulative 5-year survival rate for all the patients was 54.6 %, with no significant difference according to vascular reconstruction.
  
  
  CONCLUSIONS
  Parenchyma-sparing hepatectomy combined with vascular reconstruction is a useful option to avoid major hepatectomy among various procedures for resection of CRLM with major vascular invasion.
authors.affiliation: Department of Surgery, Nara Prefecture General Medical Center, Nara, Japan. saihoko@naramed-u.ac.jp.
authors.forename: Saiho
authors.initials: S
authors.lastname: Ko
authors.affiliation: Department of Surgery, Nara Prefecture General Medical Center, Nara, Japan.
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Kirihataya
authors.affiliation: Department of Surgery, Nara Prefecture General Medical Center, Nara, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Matsusaka
authors.affiliation: Department of Surgery, Nara Prefecture General Medical Center, Nara, Japan.
authors.forename: Tomohide
authors.initials: T
authors.lastname: Mukogawa
authors.affiliation: Department of Surgery, Nara Prefecture General Medical Center, Nara, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ishikawa
authors.affiliation: Department of Surgery, Nara Prefecture General Medical Center, Nara, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Watanabe