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

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.

Informations de copyright

2024 Translational Gastroenterology and Hepatology. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tgh.amegroups.com/article/view/10.21037/tgh-23-90/coif). K.H. reports funding from Japan Blood Products Organization, Eisai Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Kaken Pharmaceutical Co., Ltd., Taiho Pharmaceutical Co., Ltd., Chugai Pharmaceutial Co., Ltd., Bayer Yakuhin, Ltd., Tsumura & Co., Eli Lilly Japan K.K., AstraZeneca K.K., NIPRO CORPORATION, FUJIFILM Healthcare Corporation, Mochida Pharmaceutical Co., Ltd., to his institution. He received payments from EA Pharma Co., Ltd.; Jhonson and Johnson Medical (Shanghai) Limited; Asahi Kasei Pharma Corporation; Astellas Pharma Inc.; AstraZeneca K.K.; Japan Blood Products Organization; Incyte Biosciences Japan GK; Viatris Inc.; Eisai Co., Ltd.; Otsuka Pharmaceutical Co., Ltd.; Kaken Pharmaceutical Co., Ltd.; EP-SOGO Co., Ltd.; Otsuka Pharmaceutical Factory; TSUMURA & CO.; Medtronic; Johnson & Johnson K.K.; Daiichi Sankyo Company, Limited; Taiho Pharmaceutical Co., Ltd.; Chugai Pharmaceutial Co., Ltd.; Teijin Pharma Limited.; Terumo Corporation; Baxter Limited; FUJIFILM Healthcare Corporation; MIYARISAN Pharmaceutical Co for lectures, presentations, speakers bureaus, manuscript writing or educational events. The other authors have no conflicts of interest to declare.