Safety and efficacy of venous reconstruction in liver resection using cryopreserved homologous veins. (4th August 2017)

• Record Type: Journal Article
• Authors: Yamamoto, Masaki; Akamatsu, Nobuhisa; Hayashi, Akimasa; Togashi, Junichi; Sakamoto, Yoshihiro; Tamura, Sumihito; Hasegawa, Kiyoshi; Fukayama, Masashi; Makuuchi, Masatoshi; Kokudo, Norihiro
• Is Part Of: Journal of hepato-biliary-pancreatic sciences. Volume 24:Number 9(2017)
• Page Start: 511
• Page End: 519
• Publication Date: 2017-08-04
• Subjects: Cryopreserved homologous vein -- Hepatectomy -- Venous reconstruction; Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 617.556
• DOI: 10.1002/jhbp.488
• Languages: English
• ISSNs: 1868-6974

Abstract

Abstract: Background: Only a few studies have reported the resection and reconstruction of major hepatic veins during hepatectomy. Here, we present our strategy and techniques for venous reconstruction with cryopreserved homologous veins, and describe the surgical outcome. Methods: Among 2, 387 hepatectomy patients, 39 patients who required hepatic venous reconstruction were reviewed retrospectively. Venous reconstruction was performed to secure a non‐congested liver remnant volume of at least 40% of the total liver volume. Results: There was no operative mortality, and the severe morbidity rate was 5% in this series. A total of 41 veins were reconstructed; 30 with homologous veins (73.2%) and 11 with autologous veins (26.8%), with the middle hepatic vein being the most frequent ( n = 23, 56%). Interposition grafting was performed more often ( P = 0.003), the length of the venous resection was longer ( P = 0.007), and pathologic wall infiltration of the vein was revealed more often ( P = 0.002) in the homologous graft group than in the autologous graft group. The 1‐, 2‐, and 3‐year overall patency of the reconstructed veins was 55.4%, 46.3%, and 46.3%, respectively. Conclusions: Aggressive venous reconstruction during hepatectomy using cryopreserved homologous veins is a feasible option with satisfactory short‐term outcomes, and may be warranted to improve operative safety. Abstract : Highlight Yamamoto and colleagues evaluated the safety and efficacy of venous reconstruction during liver resection using cryopreserved homologous veins. Perioperative outcomes of 29 homologous graft cases showed low morbidity, no mortality and highly preserved short‐term patency rates. Using a homologous graft is a feasible option for hepatic venous reconstruction during hepatectomy.