Development of Collateral Pathways in Tumor Obstruction of Confluence of the Hepatic Veins: Neither Fortuitous nor Innocuous

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• 作者：Louise Barbier ; MD^a ; ^{louisebarbier@hotmail.fr" class="auth_mail" title="E-mail the corresponding author} ; Maxime Ronot ; MD ; PhD^b ; Marie Monsinjon ; MD^a ; Val&eacute ; rie Paradis ; MD ; PhD^c ; Olivier Soubrane ; MD ; PhD^a ; Val&eacute ; rie Vilgrain ; MD ; PhD^b ; Jacques Belghiti ; MD ; PhD^a
• 刊名：Journal of the American College of Surgeons
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：223
• 期：4
• 页码：595-601
• 全文大小：1063 K

文摘

Except in Budd-Chiari syndrome, alternative drainage pathways have been described rarely. The aim was to describe the alternative collaterals pathways due to tumor hepatic vein (HV) confluence obstruction and its impact in the setting of liver resection.

Study Design

Between 2006 and 2014, preoperative CT scans of 41 patients resected for malignant tumor(s) compressing the HV confluence were assessed for the presence of accessory veins and collateral veins. A 2:1 matched control group was used for comparison of intraoperative outcomes.

Results

Intrahepatic collaterals were observed in 28 (68%) patients, mostly between segments 3/4b and 5/4b, and subcapsular collaterals were observed in 12 (29%) patients. Patients with isolated right HV obstruction and with an accessory right HV present had fewer collateral pathways develop than patients without (6 of 10 patients [60%] vs 18 of 19 [95%]; p = 0.036). Segment 1 hypertrophy was present in only 6 (15%) patients. Compared with the control group, there was a significant increase in blood loss (900 mL [range 100 to 3,500 mL] vs 500 mL [range 100 to 2,600 mL]; p < 0.001), transfusion requirements (71% vs 15%; p < 0.001), and vascular clamping (hepatic pedicle: 85% vs 72%; p < 0.001, inferior vena cava: 41% vs 11%; p < 0.001) in case of HV obstruction.

Conclusions

Development of collateral pathways is not fortuitous and depends on the number of HVs involved and pre-existing accessory veins. The increased blood loss observed in patients with collaterals leads to consider specific vascular clamping.