Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2022; 28(31): 4351-4362
Published online Aug 21, 2022. doi: 10.3748/wjg.v28.i31.4351
Approaches to reconstruction of inferior vena cava by ex vivo liver resection and autotransplantation in 114 patients with hepatic alveolar echinococcosis
Yusufukadier Maimaitinijiati, Tuerganaili AJi, Tie-Min Jiang, Bo Ran, Ying-Mei Shao, Rui-Qing Zhang, Qiang Guo, Mao-Lin Wang, Hao Wen
Yusufukadier Maimaitinijiati, Tie-Min Jiang, Hao Wen, State Key Laboratory on Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, The First Clinical College, Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
Yusufukadier Maimaitinijiati, Tuerganaili AJi, Tie-Min Jiang, Bo Ran, Ying-Mei Shao, Rui-Qing Zhang, Qiang Guo, Mao-Lin Wang, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
Ying-Mei Shao, Hao Wen, Xinjiang Organ Transplant Institution, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
Author contributions: Maimaitinijiati Y contributed to the conception and design, and drafting of the article; Maimaitinijiati Y and Ran B contributed to the acquisition of data, analysis, and interpretation of data; Jiang TM, Tuerganaili A, and Wen H contributed to the conception and design, and provision of study material; Jiang TM, Zhang RQ, Guo Q, and Wang ML contributed to the data collection; Shao YM did provision of study material; Zhang RQ analyzed the data; Wen H did final approval of the version to be submitted.
Institutional review board statement: The study was approved by the Human Ethics Committee of the First Affiliated Hospital of Xinjiang Medical University and conducted in accordance with the Declaration of Helsinki. All data were analyzed anonymously.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hao Wen, MD, PhD, Chief Doctor, Professor, State Key Laboratory on Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, The First Clinical College, Xinjiang Medical University, No. 8 Liyushan South Road, Xinshi District, Xinjiang Uygur Autonomous Region 830011, Xinjiang, China. surgeon0309@126.com
Received: February 11, 2022
Peer-review started: February 11, 2022
First decision: May 29, 2022
Revised: June 10, 2022
Accepted: July 25, 2022
Article in press: July 25, 2022
Published online: August 21, 2022
Processing time: 186 Days and 9.9 Hours
Abstract
BACKGROUND

Hepatic alveolar echinococcosis (AE) is most commonly found in retrohepatic inferior vena cava (RHIVC). Ex vivo liver resection and autotransplantation (ELRA) can better realize the radical resection of end-stage hepatic AE with severely compromised hepatocaval confluences, and reconstruction of the affected vessels. Currently, there is a scarcity of information regarding RHIVC reconstruction in ELRA.

AIM

To propose reasonable RHICV reconstruction strategies for ex vivo liver resection and autotransplantation.

METHODS

We retrospectively summarized the clinical data of 114 patients diagnosed with hepatic AE who treated by ELRA in our department. A total of 114 patients were divided into three groups according to the different reconstruction methods of RHIVC: Group A with original RHIVC being repaired and reconstructed (n = 64), group B with RHIVC being replaced (n = 43), and group C with RHIVC being resected without reconstruction (n = 7). The clinical data of patients, including the operation time, anhepatic phase, intraoperative blood loss, complications and postoperative hospital stay, were analyzed and the patients were routinely followed up. The normally distributed continuous variables were expressed as means ± SD, whereas the abnormally distributed ones were expressed as median and analyzed by analysis of variance. Survival curve was plotted by the Kaplan-Meier method.

RESULTS

All patients were routinely followed up for a median duration of 52 (range, 12-125) mo. The 30 d mortality rate was 7.0% (8/114) and 7 patients died within 90 d. Among all subjects, the inferior vena cava (IVC)-related complication rates were 17.5% (11/63) in group A and 16.3% (7/43) in group B. IVC stenosis was found in 12 patients (10.5%), whereas thrombus was formed in 6 patients (5.3%). Twenty-two patients had grade III or higher complications, with the complication rates being 17.2%, 16.3%, and 57.1% in the three groups. The average postoperative hospital stay in the three groups was 32.3 ± 19.8, 26.7 ± 18.2, and 51.3 ± 29.4 d (P = 0.03), respectively.

CONCLUSION

ELRA can be considered a safe and feasible option for end-stage hepatic AE patients with RHIVC infiltration. The RHIVC reconstruction methods should be selected appropriately depending on the defect degree of AE lesions in IVC lumen. The RHIVC resection without any reconstruction method should be considered with caution.

Keywords: Ex vivo liver resection; Alveolar echinococcosis; Inferior vena cava; Vascular reconstruction; Liver transplantation; Artificial vessel

Core Tip: We retrospectively summarized and analyzed the clinical data of 114 patients diagnosed with hepatic alveolar echinococcosis (AE) treated by ex vivo liver resection and autotransplantation (ELRA) in our department between August 2010 and December 2020. This study is the first and largest cohort to specifically compare the different inferior vena cava (IVC) reconstruction methods in ELRA. We present a more quantitative IVC reconstruction strategy for end-stage hepatic AE patients with retrohepatic IVC infiltration based on the outcomes of this study and our experience.