Tumor involvement of the inferior vena cava (IVC) can result from primary caval leiomyosarcoma, local invasion by retroperitoneal malignant disease, or metastases. Whereas ligation of the IVC may be well tolerated if collateral circulation can be adequately preserved, collaterals must often be ligated during oncologic resection. Reconstruction of the IVC may be performed by primary repair, patch angioplasty, or interposition graft. The purpose of our study was to describe different strategies of IVC reconstruction at our institution and to measure outcomes associated with IVC reconstruction among patients with retroperitoneal malignant disease. All patients undergoing IVC reconstruction at our tertiary care hospital between November 2004 and February 2018 were identified using billing data (Current Procedural Terminology code 34502). Patients who underwent resection of the IVC for tumor involvement were enrolled in our study; data were collected on demographics, operative intervention, type of reconstruction, postoperative course, and 1-year outcomes. Patency rates were assessed by reviewing postoperative imaging including contrasted computed tomography, magnetic resonance imaging, ultrasound, and venography. One-year mortality and patency were calculated using Kaplan-Meier analysis methods. We identified 52 (46% female) patients who underwent IVC reconstruction for retroperitoneal malignant disease. Mean age was 53.6 years (range, 23-80 years). Procedures performed included primary repair (n = 17 [33%]), patch angioplasty (n = 18 [35%]), interposition grafting (n = 16 [31%]), and primary repair plus bypass (n = 1 [2%]). Mean length of stay was 16 days and did not vary significantly by group. Patients undergoing interposition graft were discharged on aspirin 81 mg daily. Thirty-day survival rate was 96.2% (95% confidence interval [CI], 90.9-100), and 1-year survival rate was 75.1% (95% CI, 62.8-87.4) as seen in Fig 1. There were no intraoperative deaths. Thirty-day primary patency rate was 96% (95% CI, 90.7-100.0), and 1-year primary patency rate was 88.8% (95% CI, 79.4-98.2). Seven patients (14%) developed nonocclusive thrombus within the IVC. Mortality was known to be due to oncologic progression in 29% of deceased patients as seen in Fig 2. IVC reconstruction is a safe option for patients requiring IVC resection during oncologic surgery as evidenced by 1-year survival of 75% and 1-year primary patency approaching 90%. Overall rate of postoperative thrombus development was low and similar across all groups. In the management of primary and secondary retroperitoneal malignant disease with IVC infiltration, IVC reconstruction should be considered to achieve appropriate oncologic resection while minimizing possible complications from caval interruption.Fig 2Survival after inferior vena cava (IVC) reconstruction (N = 52).View Large Image Figure ViewerDownload Hi-res image Download (PPT)