Rolul rezectiilor vasculare оn chirurgia hepatobiliopancreatică

Hotineanu Vladimir; Hotineanu Adrian; Burgoci Serghei; Ivancov Grigore; Sîrghi Vitalie; Cazacu Dumitru

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HOTINEANU, Vladimir, HOTINEANU, Adrian, BURGOCI, Serghei, IVANCOV, Grigore, SÎRGHI, Vitalie, CAZACU, Dumitru. Rolul rezectiilor vasculare оn chirurgia hepatobiliopancreatică. In: Chirurgia (București, Romania), 2018, nr. S1(113), pp. 71-72. ISSN 1221-9118.

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Chirurgia (București, Romania)

Numărul S1(113) / 2018 / ISSN 1221-9118

Rolul rezectiilor vasculare оn chirurgia hepatobiliopancreatică

The role of vascular resections in hepatobiliopancreatic surgery

Pag. 71-72

Hotineanu Vladimir, Hotineanu Adrian, Burgoci Serghei, Ivancov Grigore, Sîrghi Vitalie, Cazacu Dumitru

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“

Disponibil în IBN: 13 decembrie 2021

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Incidenåa tumorilor maligne a zonei hepatobiliopancreatice în ultimii ani a crescut în mod constant æi este 17,3 la 100000 de populaåie.
Rezecabilitatea tumorilor acestei zone este asociatã, în primul rînd cu invazia vascularã æi într-o masurã este determinatã de posibilitaåile
obiective æi subiective de rezecåie æi reconstrucåie a vaselor magistrale. Odatã cu progresele marcate în chimioterapie, în chirurgia
hepatobiliarã prevaleaza idea cã invazia vascularã permite efectuarea rezecåiei radicale.
Materiale æi metode: Am analizat rezultatele a 40 de rezecåii vasculare a zonei hepatobiliopancreatice. Majoritatea din ele au fost
efectuate la pacienåi cu cancer cefalopancreatic cu invazie în vena mezentericã superioarã, vena portã – 23 pacienåi, colangiocarcinom
perihilar – cu invazie în vena cavã inferioarã – 3 æi invazia venei porta – 5 pacienåi, tumori hepatice primare æi metastatice cu invazia
venei cave inferioare – 4 pacienåi æi invazia venei porta – 5 (3) pacienåi. Rezecåia marginalã venei porta/venei mezenterice superioare
(VP/VMS) cu suturare am efectuat în 13 cazuri (32,5%), rezecåia VP/VMS cu anastomozã – 11 (27,5%) cazuri, rezecåia VP/VMS cu
reconstrucåie ulilizînd grefã – 9 (22,5%). Rezecåia marginalã a venei cave am efectuat în 5 (5%) cazuri, æi în 2 (5%) cazuri am efectuat
rezecåia venei cave cu reconstrucåie cu grefa sinteticã.
Rezultate: Complicaåii specifice pentru reconstrucåie vascularã s-au determinat doar într-un caz – trombozã paråialã a grefei sintetice a
venei cave inferioare, tratatã conservativ. Un caz de mortalitate postoperatorie la pacient cu carcinom hepatocelular grefat pe cirozã
hepaticã æi trombozã tumoralã a venei cava, la care s-a efectuat hepatectomie reglatã dreaptã extinsã la lobul caudat, combinatã cu cavotomie.
Cauza decesului – insuficienåã hepaticã postrezecåie. Durata medie de spitalizare 10 – 48 de zile æi nu diferã de durata spitalizãrii
pacienåilor cu aceeasi patologie, dar fãrã rezecåie vascularã.
Concluzii: Rezultatele obåinute ne pot demonstra ca rezecåiile vasculare nu influenåeazã asupra decurgerii perioadei postoperatorii. La
fel, invazia vascularã nu poate fi consideratã ca factor de pronostic negativ în perioada postoperatorie precoce, dar permite de a
efectua intervenåii chirurgicale potenåial radicale.

Introduction: The incidence of malignant tumors of hepatobiliopancreatic zone has increased in recent years and is 17.3:100000.
The resectability of the tumors in this area is associated primarily with vascular invasion and, to a certain extent, is determined by
the objective and subjective possibilities of resection and reconstruction of the main vessels. With progress in chemotherapy, in
hepatobiliary surgery there is the idea that the vascular invasion allows radical resection.
Materials and methods: We analyzed the results of 40 vascular resections of the hepatobiliopancreatic zone. Most of these were
performed in patients with cephalopancreatic cancer with invasion in the superior mesenteric vein, portal vein - 23 patients,
perihilar cholangiocarcinoma - invasion in inferior vena cava in 3 patients and portal vein invasion - 5 patients, primary and metastatic
liver tumors with invasion of inferior vena cava - 4 patients and portal vein invasion - 5 (3) patients. In thirteen cases (32.5%)
was performed the marginal resection of portal vein/superior mesenteric vein with suturing (PV/SMV), resection PV/SMV with
anastomosis - 11 (27.5%) cases, resection PV/SMV with a graft reconstruction - 9 (22.5%). The marginal resection of the inferior
vena cava was performed in 5 (5%) cases, and in 2 (5%) cases we performed resection of the vena cava with reconstruction using
synthetic graft.
Results: Specific complications for vascular reconstruction were determined only in one case - partial thrombosis of the synthetic
graft of the inferior vena cava, treated conservatively. There was one case of postoperative mortality in patient with hepatocellular
carcinoma associated with cirrhosis and tumoral thrombosis of the inferior vena cava, in this case being performed right hepatectomy
extended to segment 1, combined with cavotomy. Cause of death – postresectional hepatic failure. The average duration of
hospitalization was 10 - 48 days and did not differ from the length of hospitalization in patients with the same pathology but
without vascular resection.
Conclusions: The results obtained can demonstrate that vascular resections do not influence the progression of the postoperative
period. Similarly, vascular invasion can not be considered as a negative prognostic factor in the early postoperative period, but allows
to perform potentially radical surgeries.

Cuvinte-cheie
rezecție vasculară, grefă vasculară,

vascular resection, vascular graft

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<dc:creator>Hotineanu, V.F.</dc:creator>
<dc:creator>Hotineanu, A.V.</dc:creator>
<dc:creator>Burgoci, S.N.</dc:creator>
<dc:creator>Ivancov, G.</dc:creator>
<dc:creator>Sîrghi, V.</dc:creator>
<dc:creator>Cazacu, D.E.</dc:creator>
<dc:date>2018-07-09</dc:date>
<dc:description xml:lang='ro'><p>Inciden&aring;a tumorilor maligne a zonei hepatobiliopancreatice &icirc;n ultimii ani a crescut &icirc;n mod constant &aelig;i este 17,3 la 100000 de popula&aring;ie.<br />Rezecabilitatea tumorilor acestei zone este asociat&atilde;, &icirc;n primul r&icirc;nd cu invazia vascular&atilde; &aelig;i &icirc;ntr-o masur&atilde; este determinat&atilde; de posibilita&aring;ile<br />obiective &aelig;i subiective de rezec&aring;ie &aelig;i reconstruc&aring;ie a vaselor magistrale. Odat&atilde; cu progresele marcate &icirc;n chimioterapie, &icirc;n chirurgia<br />hepatobiliar&atilde; prevaleaza idea c&atilde; invazia vascular&atilde; permite efectuarea rezec&aring;iei radicale.<br />Materiale &aelig;i metode: Am analizat rezultatele a 40 de rezec&aring;ii vasculare a zonei hepatobiliopancreatice. Majoritatea din ele au fost<br />efectuate la pacien&aring;i cu cancer cefalopancreatic cu invazie &icirc;n vena mezenteric&atilde; superioar&atilde;, vena port&atilde; &ndash; 23 pacien&aring;i, colangiocarcinom<br />perihilar &ndash; cu invazie &icirc;n vena cav&atilde; inferioar&atilde; &ndash; 3 &aelig;i invazia venei porta &ndash; 5 pacien&aring;i, tumori hepatice primare &aelig;i metastatice cu invazia<br />venei cave inferioare &ndash; 4 pacien&aring;i &aelig;i invazia venei porta &ndash; 5 (3) pacien&aring;i. Rezec&aring;ia marginal&atilde; venei porta/venei mezenterice superioare<br />(VP/VMS) cu suturare am efectuat &icirc;n 13 cazuri (32,5%), rezec&aring;ia VP/VMS cu anastomoz&atilde; &ndash; 11 (27,5%) cazuri, rezec&aring;ia VP/VMS cu<br />reconstruc&aring;ie uliliz&icirc;nd gref&atilde; &ndash; 9 (22,5%). Rezec&aring;ia marginal&atilde; a venei cave am efectuat &icirc;n 5 (5%) cazuri, &aelig;i &icirc;n 2 (5%) cazuri am efectuat<br />rezec&aring;ia venei cave cu reconstruc&aring;ie cu grefa sintetic&atilde;.<br />Rezultate: Complica&aring;ii specifice pentru reconstruc&aring;ie vascular&atilde; s-au determinat doar &icirc;ntr-un caz &ndash; tromboz&atilde; par&aring;ial&atilde; a grefei sintetice a<br />venei cave inferioare, tratat&atilde; conservativ. Un caz de mortalitate postoperatorie la pacient cu carcinom hepatocelular grefat pe ciroz&atilde;<br />hepatic&atilde; &aelig;i tromboz&atilde; tumoral&atilde; a venei cava, la care s-a efectuat hepatectomie reglat&atilde; dreapt&atilde; extins&atilde; la lobul caudat, combinat&atilde; cu cavotomie.<br />Cauza decesului &ndash; insuficien&aring;&atilde; hepatic&atilde; postrezec&aring;ie. Durata medie de spitalizare 10 &ndash; 48 de zile &aelig;i nu difer&atilde; de durata spitaliz&atilde;rii<br />pacien&aring;ilor cu aceeasi patologie, dar f&atilde;r&atilde; rezec&aring;ie vascular&atilde;.<br />Concluzii: Rezultatele ob&aring;inute ne pot demonstra ca rezec&aring;iile vasculare nu influen&aring;eaz&atilde; asupra decurgerii perioadei postoperatorii. La<br />fel, invazia vascular&atilde; nu poate fi considerat&atilde; ca factor de pronostic negativ &icirc;n perioada postoperatorie precoce, dar permite de a<br />efectua interven&aring;ii chirurgicale poten&aring;ial radicale.</p></dc:description>
<dc:description xml:lang='en'><p>Introduction: The incidence of malignant tumors of hepatobiliopancreatic zone has increased in recent years and is 17.3:100000.<br />The resectability of the tumors in this area is associated primarily with vascular invasion and, to a certain extent, is determined by<br />the objective and subjective possibilities of resection and reconstruction of the main vessels. With progress in chemotherapy, in<br />hepatobiliary surgery there is the idea that the vascular invasion allows radical resection.<br />Materials and methods: We analyzed the results of 40 vascular resections of the hepatobiliopancreatic zone. Most of these were<br />performed in patients with cephalopancreatic cancer with invasion in the superior mesenteric vein, portal vein - 23 patients,<br />perihilar cholangiocarcinoma - invasion in inferior vena cava in 3 patients and portal vein invasion - 5 patients, primary and metastatic<br />liver tumors with invasion of inferior vena cava - 4 patients and portal vein invasion - 5 (3) patients. In thirteen cases (32.5%)<br />was performed the marginal resection of portal vein/superior mesenteric vein with suturing (PV/SMV), resection PV/SMV with<br />anastomosis - 11 (27.5%) cases, resection PV/SMV with a graft reconstruction - 9 (22.5%). The marginal resection of the inferior<br />vena cava was performed in 5 (5%) cases, and in 2 (5%) cases we performed resection of the vena cava with reconstruction using<br />synthetic graft.<br />Results: Specific complications for vascular reconstruction were determined only in one case - partial thrombosis of the synthetic<br />graft of the inferior vena cava, treated conservatively. There was one case of postoperative mortality in patient with hepatocellular<br />carcinoma associated with cirrhosis and tumoral thrombosis of the inferior vena cava, in this case being performed right hepatectomy<br />extended to segment 1, combined with cavotomy. Cause of death &ndash; postresectional hepatic failure. The average duration of<br />hospitalization was 10 - 48 days and did not differ from the length of hospitalization in patients with the same pathology but<br />without vascular resection.<br />Conclusions: The results obtained can demonstrate that vascular resections do not influence the progression of the postoperative<br />period. Similarly, vascular invasion can not be considered as a negative prognostic factor in the early postoperative period, but allows<br />to perform potentially radical surgeries.</p></dc:description>
<dc:source>Chirurgia (București, Romania) 113 (S1) 71-72</dc:source>
<dc:subject>rezecție vasculară</dc:subject>
<dc:subject>grefă vasculară</dc:subject>
<dc:subject>vascular resection</dc:subject>
<dc:subject>vascular graft</dc:subject>
<dc:title>Rolul rezectiilor vasculare оn chirurgia hepatobiliopancreatică</dc:title>
<dc:type>info:eu-repo/semantics/article</dc:type>
</oai_dc:dc>