Hepatic Vein-sparing Hepatectomy for Colorectal Liver Metastases at the Caval Confluence

Hepatic Vein-sparing Hepatectomy for Colorectal Liver Metastases at the Caval Confluence: Validation on Intention-to-treat Analysis of a IOUS-guided Approach

Major hepatectomies are generally selected for tumors involving the hepatic vein (HV) at the caval confluence (CC). As alternative, HV reconstruction has been proposed. The present study aimed to evaluate the feasibility and safety of a HV-sparing policy guided by intraoperative ultrasonography (IOUS) in a cohort of patients having at least one colorectal liver metastasis (CLM) in contact with a HV at CC. HV section can be avoided in the large majority of cases thanking to CLMs detachment or to HV partial resection or reconstruction: this policy seems feasible, safe, reduces the need of major hepatectomies, and oncologically provides an adequate local control.

Inclusion Criteria:

• diagnosis of at least one CLM in contact with HV at caval confluence and HV patency at preoperative imaging
• at least 6 months of follow-up after surgery

Exclusion Criteria:

• suspected or ascertained thrombosis or full tumoral involvement of HV at preoperative imaging
• portal pedicle infiltration and/or thrombosis
• unresectability at laparotomy for any extra-hepatic or intrahepatic reason not related to tumor-vessel relations