Ko Saiho, Kirihataya Yuuki, Matsusaka Masanori, Mukogawa Tomohide, Ishikawa Hirofumi, Watanabe Akihiko
Department of Surgery, Nara Prefecture General Medical Center, Nara, Japan.
Ann Surg Oncol. 2016 Aug;23(Suppl 4):501-507. doi: 10.1245/s10434-016-5378-x. Epub 2016 Jul 11.
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.
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.
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.
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.
结直肠癌肝转移（CRLM）的可切除性取决于主要血管受累情况，并受化疗引起的肝损伤影响。保留肝实质并联合切除和重建受累血管可能会扩大肝切除术的适应证和安全性。
在92例行CRLM肝切除术的患者中，15例进行了主要血管切除和重建。重建的血管包括5例门静脉（PV）、9例肝主要静脉（HV）和6例下腔静脉。
所有PV重建均为直接吻合。HV采用自体肠系膜下静脉补片或髂外静脉移植重建。6例患者进行了全肝血管阻断。在9例HV重建患者中，3例肿瘤累及所有三支主要HV，其中在扩大右肝切除术后，左HV作为唯一的静脉进行了重建。在另外6例患者中，多发双侧叶肿瘤或化疗引起肝损伤的肝内肿瘤累及一或两支HV。通过重建HV进行肝实质保留以确保残余肝功能。血管重建患者的手术时间为462±111分钟，失血量为1278±528毫升。未发生Clavien-Dindo 3级及以上并发症。中位住院时间为17天（范围8 - 26天）。所有患者的累积5年生存率为54.6%，血管重建与否无显著差异。
在各种针对伴有主要血管侵犯的CRLM切除手术中，保留肝实质的肝切除术联合血管重建是避免进行大范围肝切除术的一种有效选择。
