MANAGEMENT OF MALIGNANT-TUMOR WITH INTRACAVAL EXTENSION BY SELECTIVE CLAMPING OF IVC

Background/Aim: Malignant tumors with retrohepatic intracaval extensio ns are difficult to treat. We report five cases of intracaval tumor em boli (3 hepatocellular carcinoma, 2 renal cell carcinoma). Material an d Methods: The tumor embolus is removed by the following methods accor ding to site: in. the right atrium, by open heart surgery after clampi ng of the inferior vena cava between the superior vena cava and the in trahepatic inferior vena cava and of the portal vein, in combination w ith a cardiopulmonary bypass using a pump oxygenator; above the conflu ence of the hepatic vein with the inferior vena cava, by inferior vena cava clamping between its suprahepatic and intrahepatic portions, shu nting from the inferior vena cava and the portal vein to the axillary vein; below the inferior vena cava-hepatic vein confluence, by inferio r vena cava clamping below the confluence and in the infrahepatic port ion; and around the confluence, by side clamping of the inferior vena cava, maintaining both hepatic and systemic circulations. Results: Pul monary emboli were diagnosed in. one patient. However, the patient's c ondition improved with anti-coagulant therapy. No major complication w as observed in any other patient. All patients were discharged after a mean prostoperative period of 32.8 days. One patient with HCC died of lung metastasis at 5 months and the other two, of recurrence in the r esidual portion of the liver at 4 and 16 months, and the two with RCC are still alive without recurrence of the carcinoma 9 and 14 months la ter. Conclusions: Preoperative recognition by ultrasonography, compute d tomographic scanning, cavography and especially trans-esophageal end oscopic ultrasonography is important. Vascular exclusion may also be p erformed by various techniques depending on the site of the tumor embo lus.