Surgical Resection of Malignancies Invading Inferior Vena Cava Level I and II. Issues Still Need to Be Discussed.

Abstract

Abdominal malignancies invading inferior vena cava present high postoperative morbidity and poor prognosis that has been decreasing in the last years. Our aim was to present and discuss a series of resected tumors invading the inferior vena cava from the origin of the hepatic vein to the common iliac veins (Level I and II). We retrospectively evaluated from 2005 to 2015 short- and long-term results of 20 consecutive surgical resections of tumors with associated inferior vena cava resection at Levels I and II performed at the Sanchinarro Hospital, Madrid, Spain. The series included 4 leiomyosarcomas, 3 pancreatic cancers, 2 germinal cancers, 5 renal cancers, 4 liver cancers and 2 adrenal cancers. There were 7 circular cava resections, all of them replaced by polytetrafluoroethylene (PTFE) graft and 13 primary repairs. Sapheno-femoral arterio-venous fistulas have been performed in 6 cases. Early postoperative complications occurred in 11 cases (57.9%) and mortality in one case. Graft thrombosis occurred in one case at 14 months from surgery (1/7, 14.2%). Surgical resection with combined inferior vena cava resection can be performed in selected patients with acceptable morbidity and mortality in light of the recent advancement in surgical technique.