Vena cava encirclement predicts difficult native hepatectomy

Fabrizio Panaro (1, 2) , Gildas Boisset (1, 2) , Gerald Chanques (3, 2) , Boris Guiu (2) , Astrid Herrero (1, 2, 4) , Hassan Bouyabrine (1, 2) , Georges Philippe Pageaux (1, 2) , Karim Boudjema (5, 6) , Francis Navarro (1, 2, 4)

1 Département de chirurgie digestive et transplantation
2 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
3 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
4 Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB)
5 Foie, métabolismes et cancer
6 Service de Chirurgie Hépatobiliaire et Digestive [Rennes] = Hepatobiliary and Digestive Surgery [Rennes]

Recipient hepatectomy is a challenging liver transplantation (LT) procedure that has life-threatening complications. The current predictive mortality clinic-biological scores (Child/Model for End-Stage Liver Disease [MELD]) do not take into consideration the recipient's liver anatomy. The aim of this study was to evaluate the impact of the dorsal sector anatomy of a cirrhotic liver on the morbidity/mortality rates of hepatectomy. A multicenter retrospective study (clinic-biological and morphologic) was performed from 2013 to 2014. The degree of encirclement of the inferior vena cava (IVC) by the dorsal sector of the liver was measured. The study population included 320 patients. Seventy-four (23%) patients had complete IVC encirclement. A correlation (P = 0.01) has been reported between the existence of a circular dorsal sector and the number of transfusions during LT (4 packed red blood cell [PRBC] transfusions in the group without IVC versus 7 PRBC transfusions in the other group). The existence of such anatomy increases the relative risk of early reoperation for IVC bleeding by 31% (P = 0.05). There is a correlation between alcoholic cirrhosis and dorsal-sector hypertrophy (126 cc versus 147.5 cc; P = 0.05). Concerning surgical time, we found no significant between-group differences. Compared to the severity of cirrhosis, an inverse correlation was observed between the MELD and Child scores and the dorsal sector hypertrophy (P < 0.001). No significant difference in terms of transfusion was found between the temporary portocaval shunt group (n = 168) and the other group (n = 152). The presence of a circular sector is associated with an increased risk of hemorrhage during hepatectomy, as well as an immediate postoperative risk of reoperation. Liver Transplantation 22 906-913 2016 AASLD.

Keywords: reconstruction; preservation; caudate lobe; virus-induced cirrhosis; impact; transfusion; piggyback; orthotopic liver-transplantation; temporary portacaval-shunt; requirements

Domains: Life Sciences [q-bio]; Human health and pathology; Surgery; Life Sciences [q-bio]; Human health and pathology; Hépatology and Gastroenterology

Fabrizio Panaro, Gildas Boisset, Gerald Chanques, Boris Guiu, Astrid Herrero, et al.. Vena cava encirclement predicts difficult native hepatectomy. Liver Transplantation, 2016, 22 (7), pp.906-913. ⟨10.1002/lt.24478⟩. ⟨hal-01363194⟩