Background: Treatment of CRLM with major vessel involvement is still challenging and valid data on outcomes are still rare. We analyzed our experience of hepatectomies with resection and reconstruction of major hepatic vessels with regard to operative and perioperative details, histopathological findings and oncological outcome. Methods: Data of 32 hepatectomies with major hepatic vessel resections and reconstructions were included. Results were correlated with perioperative and oncological outcome. Results: Out of 1236 surgical resections due to CRLM, we performed 35 major hepatic vessel resections and reconstructions in 32 cases (2.6%) during the study period from January 2008 to March 2023. The vena cava inferior (VCI) was resected and reconstructed in 19, the portal vein (PV) in 6 and a hepatic vein (HV) in 10 cases. Histopathological examination confirmed a vascular infiltration in 6/32 patients (VCI 3/17, HV 2/10 and PV 1/6). There were 27 R0 and 5 R1 resections. All R1 situations affected the parenchymal margin. Vascular wall margins were R0. Ninety-day mortality was 0. The median overall survival (OS) for the patient group with vascular infiltration (V1) was 21 months and for the V0 group 33.3 months. Conclusion: Liver resections with vascular resection and reconstruction are rare and histological vessel infiltration occurs seldom. In cases with presumed vascular wall infiltration, liver resection combined with major vessel resection and reconstruction can be performed with low morbidity and mortality. We prefer a parenchymal sparing liver resection with vascular resection and reconstruction to achieve negative resection margins, but in technically difficult cases with higher risk for postoperative complications, tumor detachment from vessels without resection is a most reasonable surgical alternative.
背景：对于累及主要血管的结直肠癌肝转移（CRLM）的治疗仍具挑战性，且关于治疗结局的有效数据仍较为缺乏。本研究分析了我们在进行涉及主要肝血管切除与重建的肝切除术方面的经验，重点关注手术及围手术期细节、组织病理学发现以及肿瘤学结局。 方法：研究纳入了32例涉及主要肝血管切除与重建的肝切除术数据。将手术结果与围手术期及肿瘤学结局进行相关性分析。 结果：在2008年1月至2023年3月研究期间，共进行了1236例因CRLM实施的手术切除，其中32例（2.6%）患者接受了35次主要肝血管切除与重建。具体包括：下腔静脉（VCI）切除重建19例，门静脉（PV）6例，肝静脉（HV）10例。组织病理学检查证实32例患者中有6例存在血管浸润（VCI 3/17，HV 2/10，PV 1/6）。所有切除中，27例达到R0切除，5例为R1切除。所有R1情况均涉及肝实质切缘，血管壁切缘均为R0。90天死亡率为0。血管浸润（V1）患者组的中位总生存期（OS）为21个月，无血管浸润（V0）组为33.3个月。 结论：联合血管切除与重建的肝切除术较为罕见，且组织学上的血管浸润发生率较低。对于疑似存在血管壁浸润的病例，联合主要血管切除与重建的肝切除术可以以较低的发病率和死亡率实施。我们倾向于采用保留肝实质的肝切除术联合血管切除与重建，以实现阴性切除切缘。然而，在技术难度较高、术后并发症风险较大的病例中，不切除血管而将肿瘤从血管上剥离是一种非常合理的手术替代方案。
Resection of Colorectal Liver Metastases with Major Vessel Involvement
肿瘤(癌症)患者之家