Kaneko Junichi, Hayashi Yoshihiro, Kazami Yusuke, Nishioka Yujiro, Miyata Akinori, Ichida Akihiko, Kawaguchi Yoshikuni, Akamatsu Nobuhisa, Hasegawa Kiyoshi
Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Transl Gastroenterol Hepatol. 2024 Mar 21;9:23. doi: 10.21037/tgh-23-90. eCollection 2024.
As tumors invade major abdominal veins, surgical procedures are transformed from simple and basic to complicated and challenging. In this narrative review, we focus on what is currently known and not known regarding the technical aspects of major abdominal venous resection and its reconstruction, patency, and oncologic benefit in a cross-cutting perspective.
A systematic literature search was performed in PubMed and Semantic Scholar from inception up to October 18, 2023. We reviewed 106 papers by title, abstract, and full text regarding resection or reconstruction of the inferior vena cava, hepatic vein confluence, portal vein (PV), and middle hepatic vein (MHV) tributaries in living donor liver transplantation (LDLT) in a cross-cutting perspective.
The oncologic benefit of aggressive hepatic vein resection with suitable reconstruction against adenocarcinoma remains unclear, and further studies are required to clarify this point. A superior mesenteric/PV resection is now a universal, indispensable, and effective procedure for pancreatic ductal adenocarcinoma. Although many case series using tailor-made autologous venous grafts have been reported, not only size mismatch but also additional surgical incisions and a longer operation time remain obstacles for venous reconstruction. The use of autologous alternative tissue remains only an alternative procedure because the patency rate of customized tubular conduit type to interpose or replace the resected vein is not known. Unlike arterial replacement, venous replacement using synthetic vascular grafts is still rarely reported and there are several inherent limitations except for reconstruction of tributaries of MHV in LDLT.
Various approaches to abdominal vein resection and replacement or reconstruction are technically feasible with satisfactory results. Synthetic vascular grafts may be appropriate but have a certain rate of complications.
随着肿瘤侵犯腹部主要静脉，手术操作从简单基础转变为复杂且具有挑战性。在本叙述性综述中，我们从交叉视角聚焦于目前关于腹部主要静脉切除及其重建的技术方面、通畅性和肿瘤学获益的已知与未知情况。
在PubMed和Semantic Scholar数据库中进行了从建库至2023年10月18日的系统文献检索。我们从交叉视角对106篇关于活体肝移植（LDLT）中下腔静脉、肝静脉汇合处、门静脉（PV）和肝中静脉（MHV）分支切除或重建的文献进行了标题、摘要和全文审查。
对于腺癌，采用合适重建方式进行积极肝静脉切除的肿瘤学获益仍不明确，需要进一步研究来阐明这一点。肠系膜上静脉/门静脉切除目前是胰腺导管腺癌一种通用、不可或缺且有效的手术。尽管已报道了许多使用定制自体静脉移植物的病例系列，但不仅尺寸不匹配，而且额外的手术切口和更长的手术时间仍是静脉重建的障碍。使用自体替代组织仍然只是一种替代手术，因为定制管状导管类型用于插入或替代切除静脉的通畅率尚不清楚。与动脉置换不同，使用合成血管移植物进行静脉置换的报道仍然很少，除了在LDLT中重建MHV分支外，还存在一些固有局限性。
腹部静脉切除及置换或重建的各种方法在技术上是可行的，结果令人满意。合成血管移植物可能适用，但有一定的并发症发生率。
