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Safety and efficacy of venous reconstruction in liver resection using cryopreserved homologous veins

2017; Wiley; Volume: 24; Issue: 9 Linguagem: Inglês

10.1002/jhbp.488

1868-6982

Masaki Yamamoto, Nobuhisa Akamatsu, Akimasa Hayashi, Junichi Togashi, Yoshihiro Sakamoto, Sumihito Tamura, Kiyoshi Hasegawa, Masashi Fukayama, Masatoshi Makuuchi, Norihiro Kokudo,

Liver Disease and Transplantation

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.