Outcomes of Bypass Support Use during Inferior Vena Cava Resection and Reconstruction

Abstract

The safety and effectiveness of using venovenous and cardiopulmonary bypass for resection of the inferior vena cava (IVC) is not well studied. The goal of this study was to compare outcomes following IVC resection with and without bypass support. We analyzed all patients undergoing IVC resection at our institution (September 1999 to June 2014) and compared the use of bypass support with cross-clamp alone using univariable and Kaplan-Meier analyses. The outcomes included perioperative complications and survival. Sixty-three patients underwent IVC resection (mean age 58 ± 2 years, mean follow-up 21 ± 3 months). Bypass patients (32%) were similar to non-bypass patients (68%) in age, gender, tumor size, type, and grade (P = nonsignificant [NS]). Bypass patients were more likely to undergo complete IVC reconstruction (55% vs. 24%, P = 0.01) at the suprarenal level (62% vs. 35%, P = 0.05), and had higher intraoperative blood loss (9.6 ± 2.1 vs. 3.2 ± 1.4 L, P = 0.01). Complete R0 resection was similar between groups (50% vs. 52%, P = NS). There were more overall perioperative complications in bypass patients (P = 0.0005), with a trend toward more frequent venous thromboembolic events (40% vs. 21%, P = 0.13). The incidence of acute kidney injury (10% vs. 9%) and renal failure requiring dialysis (10% vs. 2%) was similar (P = NS). Length of stay was longer following bypass (12.2 ± 1.2 vs. 8.0 ± 0.1 days, P = 0.004). There were no differences in overall mortality (15% vs. 14%, P = NS) or tumor recurrence (50% vs. 47%, P = NS). Bypass patients had a nonsignificant trend toward longer disease-free survival (20.7 ± 5.2 vs. 10.4 ± 3.8 months, P = 0.12). The use of bypass support for IVC resection is associated with more complex operations and higher rates of perioperative complications. However, the overall mortality and morbidity of bypass, including renal complications, is similar to cross-clamping alone. Thus, the need for bypass should not preclude attempts at complete tumor resection.