Autologous peritoneal graft for venous vascular reconstruction after tumor resection in abdominal surgery: a systematic
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REVIEW ARTICLE
Autologous peritoneal graft for venous vascular reconstruction after tumor resection in abdominal surgery: a systematic review Alfonso Lapergola1,3,5 · Emanuele Felli1,2,4 · Thomas Rebiere1 · Didier Mutter1,2,3 · Patrick Pessaux1,2,3,4 Received: 4 September 2019 / Accepted: 21 February 2020 © Italian Society of Surgery (SIC) 2020
Abstract Radical surgical resection (R0) is the only option to cure patients with borderline resectable or multivisceral intraabdominal malignancies involving major vessels. Autologous peritoneal flap has been described as a safe and versatile option for vascular reconstruction, but still limited experience exists regarding its use. An extensive literature review was performed to analyze results of vascular reconstruction with an autologous peritoneal graft. Fifteen reports were found for a total of 94 patients. No cases of arterial vascular reconstruction were found. Two different types of peritoneal patch have been described, backed (APFG, 30 patients) or not backed (ANFP, 64 patients) by posterior rectus sheath. A patch type of reconstruction was adopted in 70 patients (74.5%), while a tubular reconstruction in 24 (25.5%). Postoperative mortality was 5.3% (5 cases). Graft outcomes with very heterogeneous follow-ups (7 days–47 months) were available only in 85 patients (90.4%). Among them, a graft patency was documented in 80 patients (94.1%), while a stenotic graft was reported in 5 patients (5.9%). No differences in graft outcomes were observed between the patch and tubular groups (p = 0.103), nor between the ANFP and APFG groups (p = 0.625). In reported experiences, autologous peritoneal graft seems to represent a safe and versatile option for functional restoration of venous vascular anatomy after resection, especially in operations with high risk of contamination, trauma, liver transplantation and unplanned vascular resection. Unfortunately, the data available in the literature do not make it possible to draw any evidence-based conclusions on these considerations. Keywords Autologous peritoneo-fascial graft · Peritoneal patch · Autologous non-fascial peritoneum · Venous reconstruction
Introduction
* Patrick Pessaux patrick.pessaux@chru‑strasbourg.fr 1
HepatoBiliary and Pancreatic Surgery Unit, Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
2
IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
3
Institut de Recherche Contre les Cancers de l’Appareil Digestif (IRCAD), IHU-Mix Surg, 1 place de l’Hôpital, 67091 Strasbourg, France
4
Unité INSERM UMR_S1110, Institut de Recherche sur les Maladies Virales et hépatiques, Université de Strasbourg, Strasbourg, France
5
Unit of Surgical Oncology, Department of Surgery, “SS. Annunziata” Hospital, “G. D’Annunzio” University, Chieti, Italy
Major vascular tumoral involvement is no longer considered a contraindication to surgery. When technically achievable, radical surgical resection (R0) is the only treatment m
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