Trehub Yevhenii, Fretland Åsmund Avdem, Zelinskyi Artem, Kharkov Dzmitrii, Babashev Oleksii, Chieverdiuk Dmytro, Shchebetun Artem, Khyzhniak Kyrylo, Pavlovskii Maksym, Strokan Andrii, Zemskov Sergii
The Centre of Innovative Surgery and Surgical Oncology, Feofaniya Clinical Hospital of the State Management of Affairs of Ukraine, Kyiv, Ukraine.
The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Oslo, Norway.
BMJ Surg Interv Health Technol. 2024 Dec 12;6(1):e000302. doi: 10.1136/bmjsit-2024-000302. eCollection 2024.
This study aims to assess the feasibility and short-term and intermediate-term technical success rate of the concept of systematic selective hepatic vein (HV) reconstruction for parenchyma-sparing hepatectomies (PSHs) in patients with colorectal liver metastases (CRLM) in accordance with stage 2a of the IDEAL framework.
The prospective case series of patients deemed eligible and operated on according to the concept.
All patients were treated by a single surgical team in three hospitals in Ukraine from June 2022 to November 2023.
The study included nine cases of resectable CRLM with at least one lesion located in the hepatocaval confluence with HV(s) invasion, for whom reconstruction of the HV(s) allowed for additional parenchyma preservation, being an alternative to major or extended hepatectomy.
Liver resections with different types of HVs reconstruction (primary closure, patching, end-to-end anastomosis with or without grafting) were performed after a thorough evaluation of the future liver remnant volume, volume of potentially additionally preserved parenchyma and possibility of future repeat hepatectomies.
Postoperative morbidity, short-term and long-term patency of the reconstructed vessels, and the volume of additionally preserved parenchyma were the focus.
Segmental resection was performed in four cases, two with graft interposition. Patch reconstruction was performed for three HVs and two inferior vena cava resections. Two cases required primary closure. No mortality was observed, while the major morbidity rate was 33%. The short-term and long-term patency of the reconstructed HVs was 88.9% and 66.7%, respectively. HV reconstructions allowed the preservation of additional parenchyma (mean 495.4 mL, 95% CI 350.2 to 640.7). A decision-making algorithm to be used within the described approach is proposed.
Selective HV reconstruction is a feasible approach for PSH for CRLM. Further studies are needed to compare this approach to convenient major hepatectomies.
本研究旨在根据IDEAL框架的2a期，评估系统性选择性肝静脉（HV）重建概念用于结直肠癌肝转移（CRLM）患者的实质保留肝切除术（PSH）的可行性以及短期和中期技术成功率。
根据该概念对符合条件并接受手术的患者进行前瞻性病例系列研究。
2022年6月至2023年11月期间，乌克兰三家医院的所有患者均由同一手术团队治疗。
该研究纳入了9例可切除的CRLM患者，至少有一个病灶位于肝腔汇合处且伴有HV侵犯，对于这些患者，HV重建可实现额外的实质保留，是大肝切除术或扩大肝切除术的替代方案。
在对未来肝残余体积、潜在额外保留实质的体积以及未来再次肝切除的可能性进行全面评估后，进行了不同类型HV重建（一期缝合、修补、带或不带移植的端端吻合）的肝切除术。
重点关注术后发病率、重建血管的短期和长期通畅情况以及额外保留实质的体积。
4例患者进行了节段性切除，其中2例采用了移植血管置入。对3条HV进行了修补重建，并进行了2例下腔静脉切除。2例患者需要一期缝合。未观察到死亡病例，主要发病率为33%。重建HV的短期和长期通畅率分别为88.9%和66.7%。HV重建可保留额外的实质（平均495.4 mL，95%可信区间350.2至640.7）。提出了在所描述方法中使用的决策算法。
选择性HV重建是CRLM患者PSH的一种可行方法。需要进一步研究将该方法与便捷的大肝切除术进行比较。
