ASO Author Reflections: Technical Approach to Inferior Vena Cava Resection and Replacement During Liver Resection: The Role of Conventional Open Technique in the Modern Era of Minimally Invasive Hepatobiliary Surgery

Excerpt

Complete surgical resection with the goal of securing R-0 margins brings the only chance of cure for many malignant liver tumors.¹ To date, long-term overall survival is still difficult to achieve using nonoperative modalities alone, such as systemic chemo-/immunotherapy, external beam radiation, liver-directed treatments, or any combination of them. Due to its insidious intrahepatic growth, many liver tumors only present with upper abdominal symptoms at a very advanced stage. Upon presentation, patients often present with a very large liver mass with local invasion into surrounding structures/organs, such as the inferior vena cava (IVC), stomach, duodenum, pancreas, portal vein, adrenal glands, or kidneys. Locally invasive liver tumors require en bloc resection and reconstruction, which can be technically very difficult, with significant potential for developing serious postoperative morbidity and even mortality. In addition to other factors, such as financial status and the availability of advanced surgical expertise in handling major vascular resections, many patients were unfortunately deemed unresectable, and they were only referred to local/systemic palliative treatments or best supportive care as a last resort. Their overall survivals were uniformly short, usually in a matter of a few months. …