Liver tumors involving hepatic vein (HV) at caval confluence have been always considered an indication for major hepatectomy and/or HV reconstruction.However; careful study by means of intraoperative ultrasonography (IOUS) of tumor-vein relations and HV anatomy searching for accessory veins, together with color-Doppler IOUS analysis of portal flow, allows more conservative approachesalso in these patients. Indeed, in our experience, only 12% of patients, who were operated because of liver tumors in contact or in close adjacency with one or more HVs, underwent removal of at least 3 segments: none of them required HV reconstruction, and no hospital mortality was seen. Therefore, IOUS allowssparing liver parenchyma without tumor recurrence in most patients with tumors involving HV at their caval confluence, avoiding more extended hepatectomies or HV reconstructions. This approach to complex presentations of liver tumors by the use of IOUS-guidance is a further confirmation of the importance of this tool for accomplishing a safe and effective surgical treatment.

Surgical strategy for liver tumors located at the hepato-caval confluence

G. Torzilli;M. Donadon;A. Spinelli;M. Montorsi
2006-01-01

Abstract

Liver tumors involving hepatic vein (HV) at caval confluence have been always considered an indication for major hepatectomy and/or HV reconstruction.However; careful study by means of intraoperative ultrasonography (IOUS) of tumor-vein relations and HV anatomy searching for accessory veins, together with color-Doppler IOUS analysis of portal flow, allows more conservative approachesalso in these patients. Indeed, in our experience, only 12% of patients, who were operated because of liver tumors in contact or in close adjacency with one or more HVs, underwent removal of at least 3 segments: none of them required HV reconstruction, and no hospital mortality was seen. Therefore, IOUS allowssparing liver parenchyma without tumor recurrence in most patients with tumors involving HV at their caval confluence, avoiding more extended hepatectomies or HV reconstructions. This approach to complex presentations of liver tumors by the use of IOUS-guidance is a further confirmation of the importance of this tool for accomplishing a safe and effective surgical treatment.
2006
Contrast-enhanced intraoperative ultrasonography; Hepatocellular carcinoma; Intraoperative ultrasonography; Liver cirrhosis; Liver metastases; Liver surgery; Liver tumors
File in questo prodotto:
File Dimensione Formato  
31- Torzilli et al. - Ann Ital Chir. 2006 Jul-Aug.pdf

non disponibili

Tipologia: Altro materiale allegato
Licenza: Non specificato
Dimensione 5.86 MB
Formato Adobe PDF
5.86 MB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11699/6340
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 0
  • ???jsp.display-item.citation.isi??? ND
social impact