Total vascular exclusion of the liver for the resection of lesions in contact with the vena cava or the hepatic veins

Abstract

Background: This study reviews experience with total vascular exclusion of the liver (TVE), for the resection of tumours in contact with the hepatic veins or the vena cava. Methods: A retrospective study was carried out of 366 hepatic resections performed over 13 years. Forty-one patients (11 per cent) were operated under TVE. Results: Twenty-four patients were operated for malignancy and 17 for benign disease. Major hepatectomy was performed in 26 patients and minor hepatectomy in 15. The technique allowed vascular repair in eight patients. Median intraoperative blood transfusion was 2 (range 0- 26) units; 14 patients required none. Median duration of TVE was 29 (range 5- 58) min. No deaths occurred. Significant complications occurred in ten patients. Morbidity was related to the malignant nature of the lesion, duration of surgery and volume of blood transfusion, but not to duration of TVE. Conclusion: TVE facilitates resection of critically located hepatic lesions with safety and minimal blood loss. Within the limits of 1 h, prolonged TVE does not increase morbidity.