Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3844_Библиотеки_им_академика_М_И_Перельмана

The short-term survival of untreated patients with both primary and secondary liver tumours, the unpredictability of chemotherapy response on an individual patient basis and the disappointing results of transplantation for cancer provide adequate impetus for attempts to extend the boundaries of liver resection as far as possible. Most com­plex liver tumour cases, including those with significant hilar involvement, can be adequately dealt with by short periods of vascular isolation and warm ischemia, and this can often be done without caval or hepatic vein isolation. Inferior vena cava (IVC) involvement can most often be dealt with by simple venous side- clamping or in more extensive cases by total hepatic vascular isolation with IVC clamping and the selective use of veno-venous bypass, which is most often needed in the elderly. Tumours involving all of the major hepatic veins with or without direct IVC invasion, and par­ticularly tumours involving the hepatocaval confluence and needing IVC replacement, continue to pose a surgical challenge, particularly if portal hilar structures are involved bilaterally. IVC resection accounts for only 1 % of our centre’s metastatic work, as metastases rarely invade the IVC, but when considering hepatocellular carcinoma and intrahepatic cholangiocarcinoma, there appears to be a greater need.