Cardiovascular surgical experiences of IVC tumor and thrombus: Operative strategies Based on 51 consecutive patients

Abstract

Background The only beneficial treatment option for the management of inferior vena cava (IVC) tumor thrombus is complete tumor removal. The aim of this study was to report our experience in surgical and clinical outcomes in patients with tumor thrombosis in IVC. Methods A retrospective chart review of patients who underwent surgical resection of IVC tumor at our institution over the past 10 years was performed. The patients were identified using a prospectively maintained database. Results We identified 51 patients, the mean age was 53.4 ± 16.8 years, and 25.4% were female. They were divided into three groups based on tumor thrombosis level. Twenty patients (39.2%) required sternotomy, and cardiopulmonary bypass (CPB) was used in 19 (37.2%) patients, and 2 (3.9%) cases underwent coronary artery bypass graft. The perioperative complications were severe bleeding (3 patients), pulmonary embolism (2 patients), and duodenal perforation (1 patient). Three (5.8%) in-hospital deaths occurred, and all were due to severe abdominal bleeding. After a mean follow-up time of 46.5 ± 42.0 months, 29 (56.9%) patients were alive. The mean survival time was 75.2 ± 8.4 months. In multivariate analysis, higher age ( p = 0.033) and male gender ( p = 0.033) proved to be independent prognostic factors. Conclusions Tumor thrombus extending to the IVC is a rare and challenging event. Although using CPB may be safe and result in long-term survival with acceptable function, excessive bleeding during surgery may limit the use of this method.

Resection and reconstruction of the largest abdominal vein system (the inferior vena cava, hepatic, and portal vein): a narrative review

“…Level 3 thrombi extend above the hepatic vein but below the diaphragm, and level 4 thrombi extend above the diaphragm ( 22 ). Complete surgical resection of a tumor may not require complete resection of the IVC in some cases with level 3 to 4 tumor thrombi ( 23 , 24 ). In some rare cases, reconstruction of the resected IVC is not necessary because the collateral circulation is adequate due to chronic complete obstruction ( 23 , 25 ).…”