Combined Hepatic and Inferior Vena Cava Resection for Colorectal Cancer

Abstract

Hepatic metastases occur in up to half of all colorectal cancers, the third most common malignancy in the United States. Surgery provides the only chance for cure in this clinical situation and indications for resection are broadening. Colorectal metastases can invade the inferior vena cava, owing to its intimate association with the liver. While these lesions were historically classified as unresectable, surgical proficiency has progressed to the point that they can frequently be removed via a complex resection. Patient selection with the help of a multidisciplinary team and the careful use of pre-operative imaging studies is essential to maximize results. It is also critical that the operative surgeon is experienced with the complex anatomy, the resection techniques and the instruments available. While inferior vena cava invasion from colorectal cancer metastases is a poor prognostic factor, the evidence suggests that a combined hepatic and inferior vena cava resection can be performed with an acceptably low operative mortality and provides the best chance for long-term survival.