Current trends in vena cava reconstructive techniques with major liver resection: a systematic review
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SYSTEMATIC REVIEWS AND META-ANALYSES
Current trends in vena cava reconstructive techniques with major liver resection: a systematic review Maria Baimas-George 1 & Christoph Tschuor 1,2 & Michael Watson 1 & Jesse Sulzer 1 & Patrick Salibi 1 & David Iannitti 1 & John B. Martinie 1 & Erin Baker 1 & Pierre-Alain Clavien 2 & Dionisios Vrochides 1 Received: 3 August 2020 / Accepted: 7 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Historically, invasion of the inferior vena cava (IVC) represented advanced and often unresectable hepatic disease. With surgical and anesthetic innovations, IVC resection and reconstruction have become feasible in selected patients. This review assesses technical variations in reconstructive techniques and post-operative management. Methods A comprehensive literature search was performed according to PRISMA. Inclusion criteria were (i) peer-reviewed articles in English; (ii) at least three cases; (iii) hepatic IVC resection and reconstruction (January 2015–March 2020). Primary outcomes were reconstructive technique, anti-thrombotic regimen, post-operative IVC patency, and infection. Secondary outcomes included post-operative complications and malignant disease survival. Results Fourteen articles were included allowing for investigation of 351 individual patients. Analysis demonstrated significant heterogeneity in surgical reconstructive technique, anti-thrombotic management, and post-operative monitoring of patency. There was increased utilization of ex vivo approaches and decreased use of venovenous bypass compared with previously published reviews. Conclusion This review of literature published between 2015 and 2020 reveals persistent heterogeneity of hepatic IVC reconstructive techniques and peri-operative management. Increased utilization of ex vivo approaches and decreased use of venovenous bypass point towards improved operative techniques, peri-operative management, and anesthesia. In order to gain evidence for consensus on management, a registry would be beneficial. Keywords IVC resection . Reconstruction . Hepatic disease . Malignancy . Patency . Systematic review
Introduction Historically, involvement of the inferior vena cava (IVC) by hepatic tumor represented advanced, unresectable disease. With venous invasion being relatively uncommon, the true incidence has yet to be described; however, it is clearly associated with a poor prognosis [1]. Further, there is typically a poor response to chemotherapy or medical treatment, such that surgery often offers the only option for improved survival
* Dionisios Vrochides [email protected] 1
Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC 28204, USA
2
Department of Surgery & Transplantation, University Hospital of Zurich, Zurich, Switzerland
[2, 3]. Thus, beginning in the 1990s and the piggybacking off techniques used with leiomyosarcoma, case reports and series bega
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