Schipper Sandra, Zimmermann Markus, Kroh Andreas, Neumann Ulf Peter, Ulmer Tom Florian
Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.
Department of Nanomedicine and Theranostics, Institute for Experimental Molecular Imaging, RWTH University Clinic and Helmholtz Institute for Biomedical Engineering, 52074 Aachen, Germany.
J Clin Med. 2020 Apr 12;9(4):1100. doi: 10.3390/jcm9041100.
Tumors infiltrating the inferior caval vein (ICV) have been considered irresectable in the past due to high perioperative risks. Consequently, the only treatment option for these patients was best supportive care, which resulted in reduced survival. Advancements in surgical techniques have since evolved, such that combined resections of the ICV and the hepatic malignancy are being performed. The aim of this study was the evaluation of the long-term outcomes (e.g., survival) and short-term risks of this procedure. In this single-center, retrospective cohort study ( = 24), we evaluated surgical and oncological outcome for patients undergoing hepatic surgery for oncological indications in combination with resections of the ICV. In addition, we investigated which factors are associated with survival.
First, we showed that perioperative mortality is as low as 4.1%. Second, we showed that perioperative co-morbidities are acceptable for this type of advanced hepatobiliary surgery. Third, the reconstruction of the ICV by means of a patch was superior in terms of survival compared to other types of reconstructions. This finding was independent of the type or the aggressiveness of tumor or the resections status.
In our cohort, many patients had undergone (multiple) preceding visceral surgical interventions or underwent multi-visceral surgery. Despite the medical complexity, survival was encouraging in this cohort, offering novel treatment modalities with a low risk of severe morbidities.
由于围手术期风险高，过去浸润下腔静脉（ICV）的肿瘤被认为无法切除。因此，这些患者唯一的治疗选择是最佳支持治疗，这导致了生存率降低。此后，手术技术不断进步，使得ICV和肝脏恶性肿瘤的联合切除得以开展。本研究的目的是评估该手术的长期结局（如生存率）和短期风险。在这项单中心回顾性队列研究（n = 24）中，我们评估了因肿瘤适应证接受肝脏手术并联合ICV切除的患者的手术和肿瘤学结局。此外，我们调查了哪些因素与生存率相关。
首先，我们表明围手术期死亡率低至4.1%。其次，我们表明围手术期合并症对于这种类型的晚期肝胆手术是可接受的。第三，与其他类型的重建相比，采用补片重建ICV在生存率方面更具优势。这一发现与肿瘤的类型或侵袭性或切除状态无关。
在我们的队列中，许多患者之前接受过（多次）内脏手术干预或接受了多脏器手术。尽管病情复杂，但该队列的生存率令人鼓舞，提供了严重并发症风险低的新型治疗方式。
