The international surgical journal with global reach

This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Ultrasonographically guided surgical approach to liver tumours involving the hepatic veins close to the caval confluence. BJS 2006; 93: 1238-1246.

Published: 4th September 2006

Authors: G. Torzilli, M. Montorsi, D. Del Fabbro, A. Palmisano, M. Donadon, M. Makuuchi et al.

Background

Intraoperative ultrasonography (IOUS) may allow a more conservative procedure in patients with liver tumours involving a hepatic vein at the caval confluence. The aim of this study was to determine whether IOUS and colour Doppler IOUS might reduce the rate of major hepatectomy and vascular reconstruction in patients with such tumours.

Method

Of 133 consecutive patients with a liver tumour who underwent hepatectomy, 22 had involvement of a hepatic vein at the caval confluence. The surgical strategy employed was determined by IOUS findings of the relationship between the tumour and hepatic vein, the presence of accessory veins, and portal flow as measured by colour Doppler IOUS following clamping of the hepatic vein to be resected. Mortality, morbidity, major resection, hepatic vein reconstruction and local recurrence rates were evaluated.

Results

There were no hospital deaths and only one patient suffered major morbidity. Although hepatic vein resection was performed in 15 patients, only two underwent major hepatectomy and none had vascular reconstruction. No patients had tumour recurrence at a mean follow‐up of 23 months.

Conclusion

IOUS allowed sparing of the liver parenchyma without tumour recurrence in most patients with a tumour involving a hepatic vein at the caval confluence, avoiding more extensive hepatectomy or vascular reconstruction. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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