Vascular Liver Surgery: Indications and Reconstruction Techniques

Involvement of the hepatic artery, portal vein, hepatic veins, or inferior vena cava is no longer systematically considered a contraindication to liver resection. Advances in vascular reconstruction techniques, preoperative imaging, and perioperative management have expanded surgical indications, particularly for perihilar cholangiocarcinoma, intrahepatic cholangiocarcinoma, and selected colorectal liver metastases.
This presentation is based on two surgical videos illustrating complex liver resections combined with major vascular reconstructions : arterial and portal vein reconstruction performed during resection of a perihilar cholangiocarcinoma, and resection of the inferior vena cava and its tributaries for colorectal liver metastases.
The aim is to demonstrate that vascular liver surgery can now achieve curative oncological resection in patients previously considered unresectable. However, these procedures should remain restricted to expert centers with careful patient selection and specialized multidisciplinary management.