RESECTION OF THE SUPRARENAL INFERIOR VENA-CAVA - THE ROLE OF PROSTHETIC REPLACEMENT

Objective: To review the role of prosthetic replacement after resectio n of the suprarenal portion of the inferior vena cava (IVC). Design: R etrospective review of a series of six patients with malignant infiltr ation of the suprarenal IVC undergoing operation in the last 11 years. Setting: Multispecialty referral center. Patients: One primary leiomy osarcoma and five involvements of the IVC by liver carcinoma (n=2), ad renal carcinoma (n=2), and recurrent renal carcinoma (n=1). Interventi ons: En bloc resection of the tumor with the IVC under total vascular exclusion of the liver in four cases, combined major liver resection i n four cases, venous resection including the renal confluence in four cases, prosthetic venous replacement in four cases, and no venous repl acement in two cases. Main Outcome Measures: Mortality, venous patency , clinical assessment, and malignant recurrence. Results: One postoper ative death (renal failure) following extended resection with right ne phrectomy and ligature of the left renal vein. Graft patency was contr olled in survivors, with good functional result. Among two patients wi thout venous replacement, one with complete caval obstruction and mark ed collateral circulation has had a good result, and one with partial caval obstruction experienced transient symptoms of venous insufficien cy. Malignant recurrence led to death in four patients (4, 6, 37, and 42 months after surgery). Conclusions: Suprarenal IVC reconstruction i s justified in selected cases, with good functional results. When the renal confluence is resected along with the IVC, renal vein reconstruc tion may be needed to avoid acute renal failure. The oncologic results of such extensive resections are poor. Adjuvant therapy should be eva luated.