Li W, Han J, Wu ZP, Wu H. Surgical management of liver diseases invading the hepatocaval confluence based on IH classification: The surgical guideline in our center. World J Gastroenterol 2017; 23(20): 3702-3712 [PMID: 28611523 DOI: 10.3748/wjg.v23.i20.3702]
Corresponding Author of This Article
Hong Wu, MD, PhD, Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China. wuhong7801@163.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. May 28, 2017; 23(20): 3702-3712 Published online May 28, 2017. doi: 10.3748/wjg.v23.i20.3702
Surgical management of liver diseases invading the hepatocaval confluence based on IH classification: The surgical guideline in our center
Wei Li, Jun Han, Zhao-Ping Wu, Hong Wu
Wei Li, Hong Wu, Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Zhao-Ping Wu, Department of hepatobiliary surgery, Jiujiang NO.1 People’s Hospital, Jiujiang 332000, Jiangxi Province, China
Jun Han, Department of Critical Care Medicine, Sichuan Provincial Hospital for Women and Children, Chengdu 610045, Sichuan Province, China
Author contributions: Wu H proposed the study; Li W, Wu ZP and Han J performed the research and wrote the first draft; Li W collected and analyzed the data; Wu H is the guarantor; all authors contributed to the design and interpretation of the study and to further drafts, and have read and approved the final version to be published.
Institutional review board statement: All procedures described in this study were approved by the Ethics Committee of West China Hospital, Sichuan University.
Informed consent statement: We conducted interventions with the consent of patients and their families. The informed consent of usage of medical records was acquired from the hospital.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Data sharing statement: No additional unpublished data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hong Wu, MD, PhD, Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China. wuhong7801@163.com
Telephone: +86-18980601958 Fax: +86-28-85422474
Received: September 28, 2016 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 Processing time: 240 Days and 10.5 Hours
Abstract
AIM
to investigate the short-term outcomes and risk factors indicating postoperative death of patients with lesions adjacent to the hepatocaval confluence.
METHODS
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.
RESULTS
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).
CONCLUSION
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.
