Liver resection combined with excision of vena cava

Background: This study was designed to review our experience with combined partial hepatectomy and vena caval replacement for primary and metastatic l iver tumors. Study Design: The medical records of all the patients who underwent liver r esection and excision of the vena cava over a period of 13 years and 4 mont hs at a single institution were analyzed. The types of tumors fell into fou r categories: 1) metastatic, 2) primary leiomyosarcoma of the inferior vena cava, 3) tumors with direct extension to the liver, and 4) cholangiocarcin oma. Results: The perioperative mortality was 11% related to technical complicat ions and hepatic insufficiency. Other important complications included bili ary fistula and liver abscess; patients recovered from these complications without sequalae. Six of nine patients are alive with a followup from 4 mon ths to 156 months (median 66.5 months), and three of them are free of disea se. The most common sites of recurrence were lung, liver, and brain. The pa tients with leiomyosarcoma of the cava and pheochromocytoma who underwent t hese combined procedures had the longest survival. Conclusions: This small series confirms the feasibility of obtaining longte rm survival after excision of tumors that have involved portions of the liv er and the vena cava. Innovative variations on the method of vena caval rep lacement and increased awareness of these complex surgical techniques will expand the indications of hepatic resection. (J Am Coil Surg 2000;191:244-2 50, (C) 2000 by the American College of Surgeons).