演題

肝胆膵oncologic surgeryにおける血管合併切除術のポイント

[演者] 宮崎 勝:1
1:国際医療福祉大学三田病院 外科・消化器センター

Hepatobiliarypancreatic(HBP) malignancies usually involve several major vasculature's such as the inferior vena cava(IVC), hepatic vein, portal vein, and hepatic artery. Recent many studies from high-volume centers have shown that combined vascular resection could be safely undergone with acceptable surgical morbidity and mortality, and might also bring about beneficial effects on the prognosis in some selected patients with advanced HBP malignancies involving the major vasculatures. The retro-hepatic IVC is usually involved in the patients of hepatic metastases, intra-hepatic cholangiocarcinoma (ICC), and gallbladder carcinoma in a direct invasion, and also hepatocellular carcinoma (HCC) in an intra-caval extension of tumor thrombus. The combined portal vein resection with hepatectomy is usually required in the patients with ICC, hilar cholangiocarcinoma, and gallbladder cancer. Systematic review and meta-analysis of the role of vascular resection in the treatment of hilar cholangiocarcinoma by Abbas et al demonstrated that increased morbidity and mortality has been induced by combined hepatic artery resection as compared to that induced by combined portal vein resection alone. In pancreatectomy for pancreas cancer, nowadays portal vein resection combined with pancreatectomy is a safe and feasible procedure with acceptable morbidity and mortality rates. Combined celiac axis resection with distal pacreatectomy for advanced pancreas cancer have been reported to be done without remarkable increase of surgical mortality. The combined arterial resections with pancreatectomy of hepatic artery and superior mesenteric artery have been performed only in the very strictly selected patients. As to the substitutes for the reconstruction of portal vein, jugular vein, external iliac vein, left renal vein, umbilical vein, and synthetic graft have been reported. We first reported the clinical usefulness of a left renal vein graft for the reconstruction of the portal vein in 1995. As advantages of left renal vein graft for vein reconstruction in HBP surgery, a left renal vein could be obtained from a same operative field without an additional skin incision in several minutes.
Herein, I like to show the surgical procedure of combined vascular surgery in HPB oncologic surgery and also its indication and outcomes.
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