Inferior Vena Cava Resection and Reconstruction for Retroperitoneal Tumor Excision

Abstract

The purpose of this study was to review the results of resection and reconstruction of the inferior vena cava (IVC) for en bloc malignant tumor excision. We conducted a retrospective review of all patients having IVC resection for en bloc malignant tumor excision. IVC resection was categorized as suprarenal, perirenal, infrarenal, or extensive (>1 segment resected). Repairs were divided into primary, patch, or circumferential. Tumor type, perioperative morbidity, mortality, clinical graft patency, and survival (social security death index) were recorded. Between 1992 and 2010, 48 patients (24 female) had IVC resection for tumor en bloc excision. Sarcomas were most common (33; 69%: 5 [10%] primary IVC). Thirteen patients had primary IVC repair, nine patch repairs (one autogenous), and 26 had circumferential replacement with polytetrafluoroethylene (PTFE) ringed graft (12-16 mm). Extensive IVC reconstructions were performed in 17 cases of which seven involved the entire IVC with renal vein (RV) and hepatic vein reimplantation, six were suprarenal and perirenal (seven RV reimplanted), and four were infrarenal and perirenal (four RV reimplanted). All single segment (9) repairs were infrarenal. Overall morbidity was 6% (one bowel obstruction requiring surgery, one chyle leak resolved with medical therapy, and one renal failure with complete recovery [L RV reimplant, R nephrectomy]). There was no difference in morbidity between primary, patch, circumferential, and extensive reconstruction. There was no mortality. One IVC graft thrombosis was documented on follow-up (after chemotherapy/sepsis). There were two graft stenosis associated with tumor recurrence. Lower extremity edema was universally avoided. Mean long-term survival was 3.34 years (4 months to 11 years) with a significant difference between primary or patch (mean 66.7 months) and circumferential or extensive repair (mean 39.7 months; P < .005). There was no survival difference between single segment and extensive IVC repair (36.7 vs 42.8 months; P > .12). IVC resection and reconstruction for en bloc tumor excision is safe even when extensive repairs are necessary. Replacement of the IVC with a prosthetic graft avoids extremity venous complications and likely contributes to quality of survival. Survival is dependent on tumor behavior and degree of IVC involvement where primary and patch repair has a better prognosis than circumferential resection.