Resection and reconstruction of the inferior vena cava for neoplasms

Abstract

AIM:To evaluate the results of an aggressive surgical approach of resection and reconstruction of the inferior vena cava (IVC). METHODS:The approach to caval resection depends on the extent and location of tumor involvement. The supra-and infra-hepatic portion of the IVC was dissected and taped. Left and right renal veins were also taped to control the bleeding. In 12 of the cases with partial tangential resection of the IVC, the flow was reduced to less than 40% so that the vein was primarily closed with a running suture. In 3 of the cases, the lumen of the vein was significantly reduced, requiring the use of a polytetrafluoroethylene (PTFE) patch. In 2 of the cases with segmental resection of the IVC, a PTFE prosthesis was used and in 1 case, the IVC was resected without reconstruction due to shunting the blood through the azygos and hemiazygos veins. RESULTS:The mean operation time was 266 min (230-310 min) with an average intraoperative blood loss of 300 mL (200-2000 mL). The patients stayed in intensive care unit for 1.8 d (1-3 d). Mean hospital stay was 9 d (7-15 d). Twelve patients (66.7%) had no complications and 6 patients (33.3%) had the following complications: acute bleeding in 2 patients; bile leak in 2 patients; intra abdominal abscess in 1 patient; pulmonary embolism in 2 patients; and partial thrombosis of the patch in 1 patient. General complications such as pneumonia, pleural effusion and cardiac arrest were observed in the same group of patients. In all but 1 case, the complications were transient and successfully controlled. The mortality rate was 11.1% (n = 2). One patient died due to cardiac arrest and pulmonary embolism in the operation room and the second one died 2 d after surgery due to coagulopathy. With a median follow-up of 24 mo, 5 (27.8%) patients died of tumor recurrence and 11 (61.1%) are still alive, but three of them have a recurrence on computed tomography. CONCLUSION:There are a variety of options for reconstruction after resection of the IVC that offers a higher resectable rate and better prognosis in selected cases.

The use of biological grafts for reconstruction of the inferior vena cava is a safe and valid alternative: results in 32 patients in a single institution

“…The clinical results of this series are similar in many aspects to other recent series of IVC reconstruction with PTFE grafts . However, biological grafts allow superior flexibility and greater biocompatability, especially in light of their easier handling and long‐term patency without permanent anticoagulation.…”

“…Even although the risk of PTFE graft infection is low, there is increased concern where IVC resection and reconstruction is performed in association with a bilioenteric, colonic or pancreatic anastomosis . Furthermore, in spite of a patency rate between 89–100% being reported in large series of IVC reconstruction with PTFE, long‐term anticoagulation was necessary . This has led some authors to propose the use of various forms of biological grafts including APF, bovine pericardium and sutured superficial femoral vein panel graft for IVC reconstruction because these biological grafts represent a safer alternative to PTFE .…”

“…Several series have reported on the safety and satisfactory oncological outcomes of resection for tumours that originate from or infiltrate the inferior vena cava (IVC) . The optimal management of the IVC after resection is controversial, with the use of patch or interposition grafting for IVC reconstruction the most commonly used approach …”

“…A variety of materials, such as biological (autologous or heterologous) and synthetic materials, have been proposed as grafts for IVC reconstruction . The synthetic material, polytetrafluoroethylene (PTFE) has become the most commonly used material for IVC replacement because it is readily available and comes in a variety of diameters and lengths. Given the potential risk of infection and thrombosis of synthetic grafts, the optimal material for IVC reconstruction is still debated and the search for improved graft material is still ongoing…”

Oncovascular Surgery; Surgery of the Vena Cava-Related Tumors

“…Each of the case reports and series present in literature encompass a variety of tumors in terms of anatomical origin, stage, and histopathology [1,2,[16][17][18][19][20][21][22][23]. It is not applicable therefore to release a survival rate for the entity "vena cava-related tumors."…”