1 Department of Transplantation and Hepatopancreatobiliary Surgery, Lahey Hospital & Medical Center, Burlington, MA, USA.
2 Department of Interventional Cardiology, Premier Heart and Vascular Group, Pepin Heart Institute, Florida Hospital, Tampa, FL, USA.
Scand J Surg. 2019 Sep;108(3):194-200. doi: 10.1177/1457496918798213. Epub 2018 Sep 24.
Patients with liver tumors involving the inferior vena cava have a poor outcome without surgery. Liver resection en bloc with inferior vena cava resection and reconstruction is now performed in many centers. The purpose of this study is to investigate the safety and efficacy of inferior vena cava reconstruction during hepatic resection.
A review of 12 centers reporting 240 patients with combined hepatectomy and inferior vena cava resection and reconstruction for malignant tumors was performed. Sample size, patient characteristics, histological type of the tumor, method of reconstruction, complications, and long-term survival (1-, 2-, and 5-year survival) were evaluated.
A total of 240 patients from 12 institutions (male 58%) with mean age 54 years underwent combined liver resection and inferior vena cava resection and reconstruction for colorectal liver metastases (43%), cholangiocarcinomas (26%), hepatocellular carcinomas (19%), leiomyosarcomas (4%), and other tumors (7.9%). Reconstruction included primary closure (35.8%), patch repair (13.3%), or interposition graft (50.8%) In-hospital mortality was 6.25% and overall morbidity was 42.1%. 1- and 10-year survival rates were 79.7% and 28.9%, respectively.
Tumors arising in or extending to inferior vena cava that require liver resection should be considered for surgery as it can be performed with an acceptable mortality and morbidity in centers with liver transplantation and hepato-pancreato-biliary facilities.
未经手术治疗的肝肿瘤累及下腔静脉患者预后较差。目前，许多中心都在进行肝切除术联合下腔静脉切除和重建。本研究旨在探讨肝切除术中下腔静脉重建的安全性和有效性。
对 12 个中心报告的 240 例肝切除术联合下腔静脉切除和重建治疗恶性肿瘤的病例进行了回顾性分析。评估了样本量、患者特征、肿瘤组织学类型、重建方法、并发症和长期生存（1、2 和 5 年生存率）。
共有来自 12 家机构的 240 例患者（男性占 58%），平均年龄为 54 岁，因结直肠癌肝转移（43%）、胆管细胞癌（26%）、肝细胞癌（19%）、平滑肌肉瘤（4%）和其他肿瘤（7.9%）行联合肝切除术和下腔静脉切除和重建。重建方法包括直接缝合（35.8%）、补片修复（13.3%）或间置移植物（50.8%）。住院死亡率为 6.25%，总并发症发生率为 42.1%。1 年和 10 年生存率分别为 79.7%和 28.9%。
对于需要肝切除术的起源于或延伸至下腔静脉的肿瘤，应考虑手术治疗，因为在具备肝移植和肝胆胰设施的中心，其死亡率和发病率可以接受。
