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

Abstract

Background and Objectives: Retroperitoneal tumors with involvement of the inferior vena cava (IVC) often require resection of the IVC to achieve complete tumor removal. This study evaluates the safety and efficacy of IVC ligation without caval reconstruction.Methods: A retrospective chart review of patients who underwent IVC ligation (IVC-Ligation) and IVC resection with reconstruction (IVC-Reconstruction) at our institution between May 2004 and April 2021 was performed. Outcomes from the two surgical techniques were compared via univariate analysis using the Kruskal-Wallis test for continuous variables and Fisher's exact test for categorical variables.Results: Forty-nine IVC-Ligation and six IVC-Reconstruction surgeries were identified. There were no differences in baseline demographics, tumor characteristics, complication rates, postoperative morbidity, or overall 5-year survival between groups. IVC-Reconstruction patients were more likely to require intensive care unit admission (83% vs. 33%; p = 0.0257) and the IVC-Ligation cohort had a tendency to present with nondebilitating postoperative lymphedema (35% vs. 0%; p = 0.1615), which resolved for most patients.Conclusions: IVC-Ligation is a viable surgical option for select patients presenting with retroperitoneal tumors with IVC involvement and provides acceptable shortand medium-term outcomes.

A Narrative Review on Robotic Surgery as Treatment for Renal Cell Carcinoma with Inferior Vena Cava Thrombus

“…Accordingly, risks of intraoperative blood transfusions and postoperative grade III and IV complications are increased [ 29 , 34 , 40 ]. Additionally, if the tumor has invaded the IVC wall, a cavectomy may be needed and is typically followed by reconstruction with a graft, although IVC ligation without reconstruction has been demonstrated to yield acceptable near-term outcomes [ 41 , 42 ]. Gill et al were the first to publish on their experiences with RARN/IVCTT for level III thrombi.…”

Inferior vena cava reconstruction with non‐fascial autologous peritoneum: Retrospective study and literature review

“…Palacios et al. described 17 early cases of lower‐limb lymphedema in a cohort of 49 patients 13 . The mean time to resolution was 52 days, but one case was still present 9 months after surgery.…”

“…The mean time to resolution was 52 days, but one case was still present 9 months after surgery. They also reported two cases of temporary postoperative dialysis, five cases of venous thromboembolism, and six cases of postoperative chylous ascites 13 . Therefore, this technique is not advisable in cases of limited preoperative development of collateral circulation, extensive retroperitoneal dissection with disruption of collateral circulation, and clinical instability during surgery (i.e., oliguria and unstable hemodynamics) 13,14 …”

“…12 Palacios et al described 17 early cases of lower-limb lymphedema in a cohort of 49 patients. 13 The mean time to resolution was 52 days, but one case was still present 9 months after surgery. They also reported two cases of temporary postoperative dialysis, five cases of venous thromboembolism, and six cases of postoperative chylous ascites.…”

Revision Surgery is Possible in Patients With Previous Bovine Pericardium Inferior Vena Cava Reconstruction: A Case Series and Review of Literature

“…Given sufficient collateral venous return secondary to chronic thromboses, the infra-renal IVC was resected without reconstruction, a validated technique with satisfactory clinical outcomes. 4 The IVC stumps were oversewn using 3-0 PDS and the post-operative course was uncomplicated. Post-operatively, heparin 5000 units twice daily was commenced for VTE prophylaxis.…”