A cut above? Inferior vena cava resection without reconstruction: a dual-centre experience

Abstract

Objectives: To evaluate outcomes in our patients undergoing inferior vena cava (IVC) resection without reconstruction, as part of an adrenal/renal cell cancer (RCC) operation. Methods: British Association of Urological Surgeons (BAUS) Data and Audit System records were obtained for two operating surgeons, each at geographically separate urological cancer centres. Retrospectively reviewed case notes of patients who had undergone IVC resection without reconstruction as part of an adrenal/RCC operation, assessing operative parameters, length of stay, complications and follow-up status. Results: A total of Twenty-eight patients (20 right-sided tumours, 8 left sided) underwent IVC resection without reconstruction in May 2013–February 2017. No perioperative or early deaths occurred. Fourteen patients (50%) had complications: sepsis; pneumonia; congestive cardiac failure; acute kidney injury; symptomatic peripheral deep venous thrombosis; splenectomy; and significant chyle leak. At a median follow-up of 21 months (range 1–55 months) six patients (21.4%) have died and two patients (7.1%) progressed to metastatic disease, giving a 71.4% progression-free survival in this series. Conclusions: This case series illustrates our experience of IVC resection without reconstruction as an acceptably safe procedure. This should be considered as an alternative to graft reconstruction, particularly as minimal invasive approaches are being adopted. Level of Evidence: 3

Resection of retroperitoneal tumors with inferior vena cava involvement without caval reconstruction

“…Previous analyses have reported median survival of 17-65 months and a 5-year survival of 16%-67% for IVC-Reconstruction, while IVC-Ligation has a reported median survival of 21 months and a 5-year survival of 40%-62%. 2,3,5,7,15,[23][24][25]27 Results in this analysis were concordant with the pre-existing literature, as we observed a 42-month median survival and 5-year overall survival of 50% for the IVC-Reconstruction cohort and a 23-month median survival and 5-year survival of 61% for the IVC-Ligation group, which was not statistically different. This is notable as many of our patients underwent resection of IVC segments at one or more anatomical levels, including the retrohepatic IVC, and, in many instances, resection of multiple organs.…”

“…As a rare disease, long‐term survival data regarding the surgical management of retroperitoneal tumors with IVC involvement is limited to a small number of case series. Previous analyses have reported median survival of 17–65 months and a 5‐year survival of 16%–67% for IVC‐Reconstruction, while IVC‐Ligation has a reported median survival of 21 months and a 5‐year survival of 40%–62% 2,3,5,7,15,23–25,27 . Results in this analysis were concordant with the pre‐existing literature, as we observed a 42‐month median survival and 5‐year overall survival of 50% for the IVC‐Reconstruction cohort and a 23‐month median survival and 5‐year survival of 61% for the IVC‐Ligation group, which was not statistically different.…”

“…3 In previous studies, major 30-day complication rates range from 16% to 25% for IVC-Reconstruction and 4%-17% for IVC-Ligation. 15,[22][23][24][25] Although major 30-day complication rates did not differ significantly between IVC-Ligation and IVC-Reconstruction (33% vs. 25%, respectively), our IVC-Ligation cohort reported 13 major complication events. This observed rate in major complications for IVC-Ligation may be explained by age and underlying baseline performance status, as the cohort tended to be older (median age 63.5 years) with higher baseline ECOG scores.…”

“…Another major concern regarding IVC‐Ligation is the compromise of blood flow to the remaining kidney as it could lead to a decline in renal function. Interestingly, the reported need for postoperative dialysis after IVC‐Ligation is ~3.5% with several case series reporting no need for it 3,4,8,15,24 . Only two patients in our IVC‐Ligation cohort required postoperative dialysis.…”

“…Perioperative morbidity associated with IVC‐Ligation has been posited as one of the primary reasons to avoid the procedure in retroperitoneal tumors 3 . In previous studies, major 30‐day complication rates range from 16% to 25% for IVC‐Reconstruction and 4%–17% for IVC‐Ligation 15,22–25 …”