{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:56:51Z","timestamp":1790603811032,"version":"4.1.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Liver resection with vascular reconstruction is a highly complex procedure for advanced hepatobiliary tumours. This study evaluated the postoperative and oncological outcomes of this patient cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective multicentre study included patients undergoing liver resection with vascular reconstruction between 1990 and 2024 across 21 expert centres. Reconstructions involved the inferior vena cava, hepatic veins, portal vein, or hepatic artery. Primary endpoints were postoperative morbidity and 90-day mortality. Secondary endpoints included overall survival (OS), disease-free survival (DFS), and predictors of complications. Multivariable logistic regression, Kaplan\u2013Meier, and Fine\u2013Gray analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In all, 532 patients were included and classified according to surgical approach as in situ (455, 85.3%), ante situm (48, 9.2%), or ex situ (29, 5.5%). The most frequent indications were colorectal liver metastases (162, 30.4%), intrahepatic cholangiocarcinoma (139, 26.1%), and perihilar cholangiocarcinoma (106, 19.9%). The median operative time was 390 minutes. Clavien-Dindo \u2265 IIIa occurred in 217 patients (40.8%), and the 90-day mortality rate was 9.8% (52). Portal vein reconstruction independently predicted post-hepatectomy liver failure, ascites, infectious complications, and major morbidity, whereas inferior vena cava reconstruction showed a more favourable perioperative profile. Hepatic vein reconstruction was associated with greater transfusion requirements and longer operative time. Vascular graft-related complications occurred in 22.3% (58) of reconstructions and were not associated with graft type. After excluding patients with perihilar cholangiocarcinoma (426), ante situm and ex situ procedures were associated with higher rates of Clavien-Dindo \u2265 IIIa than in situ procedures (67.3% (33) and 64.3% (18) versus 35.5% (124), respectively; P &amp;lt; 0.001), longer intensive care unit stay (6.5 and 5 versus 3 days, respectively; P &amp;lt; 0.001), and higher mortality (16.3% (8) and 17.9% (5) versus 8.3% (29), respectively; P = 0.060). DFS was superior for hepatocellular carcinoma (P = 0.011), whereas perihilar cholangiocarcinoma showed a higher risk of recurrence (P = 0.022). Five-year OS was highest for sarcoma (68.8%) and hepatocellular carcinoma (42.7%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Liver resection with vascular reconstruction is feasible in specialized centres but remains associated with substantial morbidity and mortality. The in situ approach showed the most favourable perioperative outcomes, although oncological benefit varied according to tumour biology, highlighting the importance of careful patient selection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag085","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:14:18Z","timestamp":1790601258000},"source":"Crossref","is-referenced-by-count":0,"title":["Predictors of morbidity and oncological benefit after liver resection with vascular reconstruction: international collaborative study from expert centres"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1718-3352","authenticated-orcid":false,"given":"Victor","family":"Lopez-Lopez","sequence":"first","affiliation":[{"name":"Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB-Pascual Parrilla , Murcia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8108-9064","authenticated-orcid":false,"given":"Francesca","family":"Ratti","sequence":"additional","affiliation":[{"name":"Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute , Milan ,","place":["Italy"]},{"name":"Vita Salute San Raffaele University , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Maina","sequence":"additional","affiliation":[{"name":"Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute , Milan ,","place":["Italy"]},{"name":"Vita Salute San Raffaele University , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Gonzalez-Ferez","sequence":"additional","affiliation":[{"name":"Group of Applied Mathematics in Science and Engineering, Faculty of Computer Science, University of Murcia , Murcia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Daniels","sequence":"additional","affiliation":[{"name":"Hepato-Bilio-Pancreatic and Transplant Unit, St James\u2019s University Hospital, Leeds Teaching Hospitals NHS Trust , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7431-3921","authenticated-orcid":false,"given":"Nikhil","family":"Suresh","sequence":"additional","affiliation":[{"name":"Hepato-Bilio-Pancreatic and Transplant Unit, St James\u2019s University Hospital, Leeds Teaching Hospitals NHS Trust , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7811-2155","authenticated-orcid":false,"given":"Safi","family":"Dokmak","sequence":"additional","affiliation":[{"name":"Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique\u2014H\u00f4pitaux de Paris , Clichy ,","place":["France"]},{"name":"University Paris Cit\u00e9 , Paris ,","place":["France"]},{"name":"Centre de Recherche sur l\u2019nflammation, INSERM Unit\u00e9 1149 , Clichy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Karam","sequence":"additional","affiliation":[{"name":"Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique\u2014H\u00f4pitaux de Paris , Clichy ,","place":["France"]},{"name":"University Paris Cit\u00e9 , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augustin","family":"Suffisseu","sequence":"additional","affiliation":[{"name":"Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique\u2014H\u00f4pitaux de Paris , Clichy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yawen","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihao","family":"Li","sequence":"additional","affiliation":[{"name":"William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8543-661X","authenticated-orcid":false,"given":"Rory L","family":"Smoot","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Ahmad","family":"Nadeem","sequence":"additional","affiliation":[{"name":"Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic , Cleveland, Ohio ,","place":["USA"]},{"name":"Transplantation Center, Digestive Disease and Surgery Institute, Cleveland Clinic , Cleveland, Ohio ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Aucejo","sequence":"additional","affiliation":[{"name":"Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic , Cleveland, Ohio ,","place":["USA"]},{"name":"Transplantation Center, Digestive Disease and Surgery Institute, Cleveland Clinic , Cleveland, Ohio ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio","family":"Vicente","sequence":"additional","affiliation":[{"name":"General Surgery Department, Sanchinarro University Hospital, Instituto de Investigaci\u00f3n Sanitaria HM Hospitales, Jose Camilo Cela University , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Gringeri","sequence":"additional","affiliation":[{"name":"Hepato-Bilio-Pancreatic Surgery and Liver Transplantation Unit, Padova University Hospital , Padova ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Nieddu","sequence":"additional","affiliation":[{"name":"Hepato-Bilio-Pancreatic Surgery and Liver Transplantation Unit, Padova University Hospital , Padova ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0805-3863","authenticated-orcid":false,"given":"Jordi","family":"Navin\u00e9s","sequence":"additional","affiliation":[{"name":"Department of General and Digestive Surgery, Hospital Germans Trias i Pujol , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB-Pascual Parrilla , Murcia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad H","family":"Fard-Aghaie","sequence":"additional","affiliation":[{"name":"Asklepios Campus Hamburg, Department of Surgery, Division of Hepato-Bilio-Pancreatic-Surgery, Asklepios Hospital Barmbek, Semmelweis University Budapest , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Rolinger","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, and Transplant Surgery, University Hospital Tuebingen , Tuebingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leyre","family":"Serrablo","sequence":"additional","affiliation":[{"name":"Hepato-Bilio-Pancreatic Surgical Division, Miguel Servet University Hospital , Zaragoza ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Govil","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Surgery and Liver Transplantation, Apollo Hospital , Karnataka ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Archie","sequence":"additional","affiliation":[{"name":"Division of Abdominal Transplantation, Carolinas Medical Center, Atrium Health, Wake Forest University School of Medicine , Charlotte, North Carolina ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dionisios","family":"Vrochides","sequence":"additional","affiliation":[{"name":"Division of Abdominal Transplantation, Carolinas Medical Center, Atrium Health, Wake Forest University School of Medicine , Charlotte, North Carolina ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"de Santiba\u00f1es","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Hepato-Pancreato-Biliary and Liver Transplant Unit, Hospital Italiano de Buenos Aires , Buenos Aires ,","place":["Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"de Santiba\u00f1es","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Hepato-Pancreato-Biliary and Liver Transplant Unit, Hospital Italiano de Buenos Aires , Buenos Aires ,","place":["Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Di Benedetto","sequence":"additional","affiliation":[{"name":"Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena \u2018Policlinico\u2019, University of Modena and Reggio Emilia, Modena ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvio M P","family":"Balzan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Moinhos de Vento , Porto Alegre ,","place":["Brazil"]},{"name":"Hepatobiliary and Pancreatic Surgery Center, Saint Gallen Clinic , Santa Cruz do Sul ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6274-5911","authenticated-orcid":false,"given":"Cristina","family":"Dopazo","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Surgery and Liver Transplantation, Vall d'Hebron University Hospital, Autonomous University of Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente","family":"Borrego Estella","sequence":"additional","affiliation":[{"name":"General and Digestive Surgery Department, HCU Lozano Blesa of Zaragoza, Hospital Cl\u00ednico Universitario Lozano Blesa , Saragossa ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe Kito","family":"Fusai","sequence":"additional","affiliation":[{"name":"Hepato-Bilio-Pancreatic and Liver Transplant Unit, Royal Free Hospital , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6557-0712","authenticated-orcid":false,"given":"Fernando","family":"Rotellar Sastre","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cl\u00ednica Universidad de Navarra, University of Navarra , Pamplona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto I","family":"Troisi","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Division of Hepato-Bilio-Pancreatic, Minimally Invasive and Robotic Surgery, Transplantation Center, Federico II University Hospital , Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Serrablo","sequence":"additional","affiliation":[{"name":"Hepato-Bilio-Pancreatic Surgical Division, Miguel Servet University Hospital , Zaragoza ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvio","family":"Nadalin","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, and Transplant Surgery, University Hospital Tuebingen , Tuebingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl J","family":"Oldhafer","sequence":"additional","affiliation":[{"name":"Asklepios Campus Hamburg, Department of Surgery, Division of Hepato-Bilio-Pancreatic-Surgery, Asklepios Hospital Barmbek, Semmelweis University Budapest , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esteban","family":"Cugat","sequence":"additional","affiliation":[{"name":"Department of General and Digestive Surgery, Hospital Germans Trias i Pujol , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2310-0245","authenticated-orcid":false,"given":"Umberto","family":"Cillo","sequence":"additional","affiliation":[{"name":"Hepato-Bilio-Pancreatic Surgery and Liver Transplantation Unit, Padova University Hospital , Padova ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9385-9847","authenticated-orcid":false,"given":"Andrea","family":"Schlegel","sequence":"additional","affiliation":[{"name":"Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic , Cleveland, Ohio ,","place":["USA"]},{"name":"Transplantation Center, Digestive Disease and Surgery Institute, Cleveland Clinic , Cleveland, Ohio ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4666-5337","authenticated-orcid":false,"given":"Patrick","family":"Starlinger","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2397-4599","authenticated-orcid":false,"given":"Mickael","family":"Lesurtel","sequence":"additional","affiliation":[{"name":"Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique\u2014H\u00f4pitaux de Paris , Clichy ,","place":["France"]},{"name":"University Paris Cit\u00e9 , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7729-2468","authenticated-orcid":false,"given":"Luca","family":"Aldrighetti","sequence":"additional","affiliation":[{"name":"Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute , Milan ,","place":["Italy"]},{"name":"Vita Salute San Raffaele University , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre Alain","family":"Clavien","sequence":"additional","affiliation":[{"name":"Department of Surgery and Transplantation, University of Zurich , Zurich ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Azoulay","sequence":"additional","affiliation":[{"name":"Centre H\u00e9pato-Biliaire, Department of Surgery, H\u00f4pital Paul Brousse, Assistance Publique-H\u00f4pitaux de Paris , Villejuif ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8771-4214","authenticated-orcid":false,"given":"Peter","family":"Lodge","sequence":"additional","affiliation":[{"name":"Hepato-Bilio-Pancreatic and Transplant Unit, St James\u2019s University Hospital, Leeds Teaching Hospitals NHS Trust , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0007-562X","authenticated-orcid":false,"given":"Ricardo","family":"Robles Campos","sequence":"additional","affiliation":[{"name":"Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB-Pascual Parrilla , Murcia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"2026092809140119000_zrag085-B1","doi-asserted-by":"crossref","first-page":"1764","DOI":"10.1002\/bjs.9295","article-title":"Vascular reconstruction combined with liver resection for malignant tumours","volume":"100","author":"Azoulay","year":"2013","journal-title":"Br J Surg"},{"key":"2026092809140119000_zrag085-B2","doi-asserted-by":"crossref","first-page":"2217","DOI":"10.1007\/s00423-021-02310-w","article-title":"Vascular surgery in liver resection","volume":"406","author":"Radulova-Mauersberger","year":"2021","journal-title":"Langenbecks Arch Surg"},{"key":"2026092809140119000_zrag085-B3","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1016\/j.hpb.2023.05.365","article-title":"Liver surgery in the 2020s: ante-situm and in-situ resection are still indicated\u2014a single-center 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