Inferior vena cava resection without reconstruction for retroperitoneal malignancies

Abstract

Inferior vena cava (IVC) involvement in retroperitoneal malignancies is a rare occurrence and radical surgery with major vascular resection represents the only potential curative treatment. IVC replacement after resection is still controversial and only small series and few prospective data are available. We report a series of three patients affected by retroperitoneal masses involving IVC treated with vena cava resection without replacement. All patients were treated by a radical R0 surgical procedure associated with infrarenal IVC resection and no reconstruction. Based on preoperative radiologic imaging and intraoperative findings, one patient also underwent right nephrectomy, while another patient underwent left renal vein ligation without nephrectomy. Neither early nor late severe post-operative complications related to the absence of IVC outflow were observed. Resection without replacement of the infrarenal IVC results in acceptable morbidity, thus specific risks related to the use of prosthetic grafts can be avoided.

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

“…Indications for IVC resection are case-dependent and are usually recommended when the tumor emanates from or invades the caval wall, or it is inseparable from the caval lumen. 2,4,5 Due to the rarity of the tumors involving the IVC primarily or secondarily, there is no general consensus on how to proceed after IVC resection, with groups advocating for either ligation without reconstruction or resection with reconstruction depending on their center's expertise. 2,3,5,7,15,22 In this analysis of 55 retroperitoneal tumors of multiple Perioperative morbidity associated with IVC-Ligation has been posited as one of the primary reasons to avoid the procedure in retroperitoneal tumors.…”

“…Complete excision of these tumors, often renal cell carcinomas (RCCs) or retroperitoneal sarcomas, may require resection of the IVC to achieve complete tumor removal with negative margins. This provides patients with the best chance for long‐term disease‐free and overall survival 1–7 …”

“…This provides patients with the best chance for long-term disease-free and overall survival. [1][2][3][4][5][6][7] At the moment, there is no established consensus on whether IVC-Reconstruction or IVC-Ligation is the preferred method for optimal management following IVC resection. 2,[6][7][8] En bloc, radical resection of the tumor and IVC theoretically indicates a need for reconstruction.…”

Double inferior vena cava systems during retroperitoneal surgery: Description of a systematic approach to a rare and challenging anatomic variant

“…In addition, ligation can be considered for chronic left IVC occlusion such as can occur with tumor thrombus occluding a left IVC. 13 In such a setting, the left IVC will be dilated and the absence of left lower limb edema will suggest the presence of acceptable venous collateral circulation. In the present patient, the left IVC was not dilated, albeit not obstructed by the tumor thrombus.…”

En Bloc Resection of Right Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus Without Caval Reconstruction: Is It Safe to Divide the Left Renal Vein?

“…A few case reports of retroperitoneal masses including sarcomas, Wilms tumor, RCC, and testicular tumors with TT and IVC obstruction necessitating IVC resection have suggested that IVC reconstruction is not required when adequate collateral circulation is present, although a transient rise in creatinine may occur postoperatively (10)(11)(12). This may be the result of hemodynamic changes or volume depletion during surgery, in which case improvement is expected over days to weeks after surgery.…”