Resection and reconstruction of the largest abdominal vein system (the inferior vena cava, hepatic, and portal vein): a narrative review

Junichi Kaneko; Yoshihiro Hayashi; Yusuke Kazami; Yujiro Nishioka; Akinori Miyata; Akihiko Ichida; Yoshikuni Kawaguchi; Nobuhisa Akamatsu; Kiyoshi Hasegawa

doi:10.21037/tgh-23-90

Resection and reconstruction of the largest abdominal vein system (the inferior vena cava, hepatic, and portal vein): a narrative review

Transl Gastroenterol Hepatol. 2024 Mar 21:9:23. doi: 10.21037/tgh-23-90. eCollection 2024.

Authors

Junichi Kaneko¹, Yoshihiro Hayashi¹, Yusuke Kazami¹, Yujiro Nishioka¹, Akinori Miyata¹, Akihiko Ichida¹, Yoshikuni Kawaguchi¹, Nobuhisa Akamatsu¹, Kiyoshi Hasegawa¹

Affiliation

¹ Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Abstract

Background and objective: As tumors invade major abdominal veins, surgical procedures are transformed from simple and basic to complicated and challenging. In this narrative review, we focus on what is currently known and not known regarding the technical aspects of major abdominal venous resection and its reconstruction, patency, and oncologic benefit in a cross-cutting perspective.

Methods: A systematic literature search was performed in PubMed and Semantic Scholar from inception up to October 18, 2023. We reviewed 106 papers by title, abstract, and full text regarding resection or reconstruction of the inferior vena cava, hepatic vein confluence, portal vein (PV), and middle hepatic vein (MHV) tributaries in living donor liver transplantation (LDLT) in a cross-cutting perspective.

Key content and findings: The oncologic benefit of aggressive hepatic vein resection with suitable reconstruction against adenocarcinoma remains unclear, and further studies are required to clarify this point. A superior mesenteric/PV resection is now a universal, indispensable, and effective procedure for pancreatic ductal adenocarcinoma. Although many case series using tailor-made autologous venous grafts have been reported, not only size mismatch but also additional surgical incisions and a longer operation time remain obstacles for venous reconstruction. The use of autologous alternative tissue remains only an alternative procedure because the patency rate of customized tubular conduit type to interpose or replace the resected vein is not known. Unlike arterial replacement, venous replacement using synthetic vascular grafts is still rarely reported and there are several inherent limitations except for reconstruction of tributaries of MHV in LDLT.

Conclusions: Various approaches to abdominal vein resection and replacement or reconstruction are technically feasible with satisfactory results. Synthetic vascular grafts may be appropriate but have a certain rate of complications.

Keywords: Inferior vena cava (IVC); autologous alternative tissue; hepatic vein confluence; narrative review; portal vein (PV).

Publication types

Review