Published online May 28, 2017. doi: 10.3748/wjg.v23.i20.3702
Peer-review started: September 29, 2016
First decision: November 21, 2016
Revised: January 15, 2017
Accepted: April 12, 2017
Article in press: April 12, 2017
Published online: May 28, 2017
to investigate the short-term outcomes and risk factors indicating postoperative death of patients with lesions adjacent to the hepatocaval confluence.
We retrospectively analyzed 54 consecutive patients who underwent hepatectomy combined with inferior vena cava (IVC) and/or hepatic vein reconstruction (HVR) from January 2012 to January 2016 at our liver surgery center. The patients were divided into 5 groups according to the range of IVC and hepatic vein involvement. The patient details, indications for surgery, operative techniques, intra- and postoperative outcomes were compared among the 5 groups. Univariate and multivariate analyses were performed to explore factors predictive of overall operative death.
IVC replacement was carried out in 37 (68.5%) patients and HVR in 17 (31.5%) patients. Type I2H2 had the longest operative blood loss, operative duration and overall liver ischemic time (all, P < 0.05). Three patients of Type I3H1 with totally occluded IVC did not need IVC reconstruction. Total postoperative morbidity rate was 40.7% (22 patients) and the operative mortality rate was 16.7% (9 patients). Factors predictive of operative death included IVC replacement (P = 0.048), duration of liver ischemia (P = 0.005) and preoperative liver function being Child-Pugh B (P = 0.025).
IVC replacement, duration of liver ischemia and preoperative poor liver function were risk factors predictive of postoperative death. We should be cautious about IVC replacement, especially in Type I2H2. For Type I3H1, it was unnecessary to replace IVC when the collateral circulation was established.
Core tip: The proposed IH classification, which divided the patients into 5 groups according to the range of vascular invasion, may be meaningful in selecting procedures for patients with hepatocaval confluence infiltration. inferior vena cava replacement, duration of liver ischemia and preoperative poor liver function were risk factors predictive of postoperative death for patients with lesions adjacent to the hepatocaval confluence.