Resection of Retro-Hepatic Vena Cava (RHVC) En-bloc with Caudate Lobe without Vascular Exclusion for a Low Grade Leiomyosarcoma of Inferior Vena Cava
© 2021. The Author(s)..
BACKGROUND: Leiomyosarcomas (LMS) of the inferior vena cava (IVC) originate in the retrohepatic (RHVC) portion in 15% of cases.1 Due to complex anatomy and need to preserve venous outflow from the infra-diaphragmatic viscera, the operation may require total vascular exclusion, veno-venous bypass and hypothermic liver resections.2,3 In this video, virtual planning of the operation allowed a parenchyma-sparing radical resection in a patient with limited liver reserve.
METHODS: A 12-cm LMS of RHVC invading the entire segment 1 (i.e., Spiegel's lobe, paracaval portion, and caudate process) was diagnosed in a man with metabolic steato-hepatitis (BMI: 34). He had no response to previous chemotherapy. Major hepatectomy was excluded considering the high risk of postoperative liver failure. 3D-reconstruction of regional anatomy allowed planning of a parenchymal-sparing, en bloc resection of tumor, RHVC, and caudate lobe while avoiding hilar and suprahepatic venous clamping.
RESULTS: The operation strategy relied on the en bloc separation of caudate lobe, RHVC, and tumor from the hepatic veins confluence and the posterior segments after complete mobilization of the liver. Vessel loop-assisted hanging maneuver, encircling tumor, and RHVC with superimposed 3D-reconstructions guided the parenchymal transection, while preserving the middle hepatic vein outflow. RHVC was replaced with prosthetic material.
CONCLUSIONS: Complex resection of primary tumor of the IVC en bloc with caudate lobe and RHVC can be attempted in chronic liver diseases at-risk of postoperative failure. Preservations of transhepatic flow and liver function depends on tumor size and preservation of noninvaded hepatic-veins confluence. Preoperative virtual 3D reconstruction is crucial in surgical planning.
| Errataetall: |
CommentIn: Ann Surg Oncol. 2021 Oct;28(11):6850-6851. - PMID 33389286 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:28 |
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| Enthalten in: |
Annals of surgical oncology - 28(2021), 11 vom: 22. Okt., Seite 6848-6849 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Altomare, Michele [VerfasserIn] |
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| Links: |
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| Themen: |
3D virtual reconstruction |
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| Anmerkungen: |
Date Completed 27.09.2021 Date Revised 19.10.2021 published: Print-Electronic CommentIn: Ann Surg Oncol. 2021 Oct;28(11):6850-6851. - PMID 33389286 Citation Status MEDLINE |
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| doi: |
10.1245/s10434-020-09428-z |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM32043365X |
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| 100 | 1 | |a Altomare, Michele |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Resection of Retro-Hepatic Vena Cava (RHVC) En-bloc with Caudate Lobe without Vascular Exclusion for a Low Grade Leiomyosarcoma of Inferior Vena Cava |
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| 500 | |a Date Completed 27.09.2021 | ||
| 500 | |a Date Revised 19.10.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Ann Surg Oncol. 2021 Oct;28(11):6850-6851. - PMID 33389286 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021. The Author(s). | ||
| 520 | |a BACKGROUND: Leiomyosarcomas (LMS) of the inferior vena cava (IVC) originate in the retrohepatic (RHVC) portion in 15% of cases.1 Due to complex anatomy and need to preserve venous outflow from the infra-diaphragmatic viscera, the operation may require total vascular exclusion, veno-venous bypass and hypothermic liver resections.2,3 In this video, virtual planning of the operation allowed a parenchyma-sparing radical resection in a patient with limited liver reserve | ||
| 520 | |a METHODS: A 12-cm LMS of RHVC invading the entire segment 1 (i.e., Spiegel's lobe, paracaval portion, and caudate process) was diagnosed in a man with metabolic steato-hepatitis (BMI: 34). He had no response to previous chemotherapy. Major hepatectomy was excluded considering the high risk of postoperative liver failure. 3D-reconstruction of regional anatomy allowed planning of a parenchymal-sparing, en bloc resection of tumor, RHVC, and caudate lobe while avoiding hilar and suprahepatic venous clamping | ||
| 520 | |a RESULTS: The operation strategy relied on the en bloc separation of caudate lobe, RHVC, and tumor from the hepatic veins confluence and the posterior segments after complete mobilization of the liver. Vessel loop-assisted hanging maneuver, encircling tumor, and RHVC with superimposed 3D-reconstructions guided the parenchymal transection, while preserving the middle hepatic vein outflow. RHVC was replaced with prosthetic material | ||
| 520 | |a CONCLUSIONS: Complex resection of primary tumor of the IVC en bloc with caudate lobe and RHVC can be attempted in chronic liver diseases at-risk of postoperative failure. Preservations of transhepatic flow and liver function depends on tumor size and preservation of noninvaded hepatic-veins confluence. Preoperative virtual 3D reconstruction is crucial in surgical planning | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Video-Audio Media | |
| 650 | 4 | |a 3D virtual reconstruction | |
| 650 | 4 | |a Augmented reality | |
| 650 | 4 | |a Inferior vena cava | |
| 650 | 4 | |a Sarcoma surgery | |
| 650 | 4 | |a Transplant surgery | |
| 700 | 1 | |a Sposito, Carlo |e verfasserin |4 aut | |
| 700 | 1 | |a Regalia, Enrico |e verfasserin |4 aut | |
| 700 | 1 | |a Coppa, Jorgelina |e verfasserin |4 aut | |
| 700 | 1 | |a Flores, Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Manzo, Elena |e verfasserin |4 aut | |
| 700 | 1 | |a Droz Dit Busset, Michele |e verfasserin |4 aut | |
| 700 | 1 | |a Mazzaferro, Vincenzo |e verfasserin |4 aut | |
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