Surgical resection and inferior vena cava reconstruction for treatment of the malignant tumor: technical success and outcomes

Abstract

Objective: The purpose of this study was to review patients who underwent inferior vena cava (IVC) resection with concomitant malignant tumor resection and to consider the operative procedures and the outcomes.

Materials and methods: Between 2000 and 2012, 41 patients underwent resection of malignant tumors concomitant with surgical resection of the IVC at our institute. The records of these patients were retrospectively reviewed.

Results: Primary tumor resections included nephrectomy, hepatectomy, retroperitoneal tumor extirpation, lymph node dissection, and pancreaticoduodenectomy. The IVC interventions were partial resection in 23 patients and total resection in 18 patients. Four patients underwent IVC replacement. Operation-related complications included pulmonary embolism, acute myocardial infarction, deep vein thrombosis, leg edema and temporary hemodialysis. There were no operative deaths. The mean follow-up period was 24.9 months (range: 2-98 months). The prognosis depended on the type and stage of the tumor.

Conclusion: Resection and reconstruction of the IVC can be performed safely if the preoperative evaluations and surgical procedures are performed properly. The IVC resection without reconstruction was permissive if the IVC was completely obstructed preoperatively, but it may also be considered in cases where the IVC is not completely obstructed.

Keywords: inferior vena cava; inferior vena cava reconstruction; inferior vena cava replacement; inferior vena cava resection; malignant tumor.

Fig. 1

Inferior vena cava (IVC) clamp level and the changes in blood pressure. (A) The IVC clamp level and the number of patients. SH: suprahepatic clamp; SR: suprarenal clamp; IR: infrarenal clamp; HV: hepatic vein; RV: renal vein. (B) The changes in systolic blood pressure before and during clamping. The filled circle is the mean systolic blood pressure.

Fig. 2

Inferior vena cava (IVC) intervention and the number of the patients. RRV: right renal vein; LRV: left renal vein; HV: hepatic vein.

Fig. 3

Replacements of the inferior vena cava (IVC), the site, type of graft, disease, and graft patency. rSFV: reversed superficial femoral vein; HV: hepatic vein; RV: renal vein.

Fig. 4

(A) The ePTFE graft with a diameter of 20 mm, The intraoperative picture of suprarenal inferior vena cava (IVC) replacement. (B) Postoperative enhanced computed tomography (CT). Three months after the infrarenal IVC replacement with ePTFE with a diameter of 20 mm. An arrow shows the ePTFE graft with a smooth thrombus inside.