Single‐Centre Experience of Supra‐Renal Vena Cava Resection and Reconstruction

Abstract

Background Tumours involving the supra‐renal segment of IVC have dismal prognosis if left untreated. Currently, aggressive surgical management is the only potentially curative treatment but is associated with relatively high morbidity and mortality. This study aims to evaluate perioperative factors, associated with adverse postoperative outcomes, based on the perioperative characteristics and type of IVC reconstruction. Methods We identified 44 consecutive patients, who underwent supra‐renal IVC resection with a mean age of 57.3 years. Isolated resection of IVC was performed in four patients, concomitant liver resection was performed in 27 patients and other associated resection in 13 patients. Total vascular exclusion was applied in 21 patients, isolated IVC occlusion in 11 patients. Neither venovenous bypass (VVB) nor hypothermic perfusion was used in any of the cases. Results The mean operative time was 205 min (150–324 min) and the mean estimated blood loss was 755 ml (230–4500 ml). Overall morbidity was 59% and major complications (Dindo‐Clavien ≥ III) occurred in 11 patients (25%). The 90‐day mortality was 11% (5pts). Intraoperative haemotransfusion was significantly associated with postoperative general complications (p < 0,001). With a mean follow‐up of 26.2 months, the actuarial 1‐, 3‐ and 5‐year survival is 69%, 34%, and 16%, respectively. Conclusions IVC resection and reconstruction in the aspect of aggressive surgical management of malignant disease confers a survival advantage in patients, often considered unresectable. When performed in experienced centres it is associated with acceptable morbidity and mortality.

Surgery of Colorectal Liver Metastases Involving the Inferior Vena Cava: A Systematic Review

“…Long-term survival is the most important parameter to assess oncological outcomes for malignant tumours. In the case of IVC resection, the 5-year OS rate ranged from 0% [45] to 51.9% [27], rising to a value of 7.1% in this review, the largest as far as we know. Since there is no other effective alternative therapy for these patients, [16,17,[19][20][21][22][23][24]26,27,29,30,[32][33][34][35][36][37]40,41,44].…”

“…Vascular control was adapted in all the cases during surgery with the objective of minimizing intra-operative bleeding, shortening the ischaemia time, maintaining haemodynamic stability, and improving the tolerance to ischaemia-reperfusion injury of the remnant liver [26,45].…”

“…The survival outcomes described in eight papers [19,27,29,32,35,36,38,45] are summarized in Table 2. The five-year overall survival (OS) ranged from 0 to 51.9%, with an MS of 16-34 months and a DFS of 9-13 months.…”