Surgery of colorrectal liver metastases involving the inferior vena cava

Abstract

Background: Liver resection remains the only potentially curative treatment for metastatic tumours of the liver. In the past, suspected involvement of inferior vena cava (IVC) was considered a contraindication for liver resection. The developement of technical innovations have made it possible to perform combined liver and IVC resections and favourable clinical outcomes have been reported. Material & Methods: A systematic review of the literature is performed to evaluate the safety and efficacy of combined liver and IVC resection in patients with colorrectal liver metastases involving IVC. Results: A total of 151 patients were described in 16 articles eligible. The studies were observational. Mean age was 58 years (range 35-84). We included 66 men and 53 women (2 studies did not include the sex). The mean number of resected metastases was 2.2 (range 1-27). The most frequent hepatic resections were: 36 right hepatectomies, 21 right trisectionectomies, 21 segmentectomies, 10 left hepatectomies, 8 extended right hepatectomies, 7 extended left hepatectomies, and 6 left trisectionectomies. In 3 cases diaphragm was resected, in 3 the right adrenal gland and in 1 the right kidney. The most performed types of vascular control were: total vascular exclusion in 63 cases, lateral clamping in 42 cases, and total vascular exclusion with hepatic hypothermic perfusion in 6 cases. Postoperative morbidity was 45.6%, mortality was 4.5%. Survival at 3 and 5 years was 55.6% and 32%. The mean follow-up was 22.7 months, and the median disease-free time was 10.5 months. Conclusions: Technical surgical advances allow the increasing resection of patients with liver metastases of colorectal cancer involving IVC. Published perioperative morbidity and mortality are comparable to the data published for this type of tumors without involvement of IVC. In the absence of prospective randomized studies, the IVC resection is safe and feasible in high-volume centers.