Resection of the inferior vena cava for neoplasms with or without prosthetic replacement: A 14-patient series

Objective To review the outcome of resection of the suprarenal or infrarena l inferior vena cava (IVC) and possible indications for prosthetic replacem ent. Summary Background Data Involvement of the IVC has long been considered a l imiting factor for curative surgery for advanced tumors because the surgica l risks are high and the long-term prognosis is poor. Prosthetic replacemen t of the IVC is controversial. Methods The authors retrospectively reviewed a 7-year series of 14 patients who underwent en bloc resection including a circumferential segment of the IVC. The tumor was malignant in 12 patients and benign in 2. The resected segment of the IVC was located above the kidneys in eight patients and belo w in six. Resection was performed without extracorporeal circulation in all patients. Results In all but one patient, IVC resection was associated with multivisc eral resection, including extended nephrectomy (n = 8), major hepatic resec tion (n = 3), digestive resection (n = 3), and infrarenal aortic replacemen t (n = 2). Prosthetic replacement of the IVC was performed in eight patient s cases and was more common after resection of a suprarenal (6/8) than an i nfrarenal segment of the IVC (2/6). One patient died of multiorgan failure, Major complications occurred in 29% of patients. Symptomatic complications of prosthetic replacement occurred in one patient (acute postoperative thr ombosis, successfully treated by surgical disobstruction). Graft-related in fection was not observed, Marked symptoms of venous obstruction developed i n three of the six patients who did not undergo venous replacement. In pati ents undergoing surgery for malignant disease, the estimated median surviva l was 37 months and the actuarial survival rate was 67% at 1 year. Conclusion Multivisceral resection including a segment of IVC is justified to achieve complete extirpation in selected patients with extensive abdomin al tumors. Prosthetic replacement of the IVC may be required, particularly in cases of suprarenal resection, It is a safe procedure with a low complic ation rate and good functional results.