Resection Of Inferior Vena Cava Research Articles

Impact of Left Renal Vein Ligation on Renal Function Following En Bloc Resection of Segmental Inferior Vena Cava and Right Kidney.

Renal function after left renal vein (LRV) ligation following en bloc resection of segmental inferior vena cava (IVC) and right kidney is understudied. We assessed the impact of LRV ligation on postoperative renal function following en bloc resection of segmental IVC and right kidney. We retrospectively reviewed 28 patients who underwent LRV ligation during en bloc resection of segmental IVC and right kidney. Patient demographics, tumor characteristics, intraoperative factors, complications, length of hospital and intensive care unit (ICU) stay, and patient survival were collected. Pre- and postoperative renal function was retrospectively analyzed. Twenty patients underwent robot-assisted surgery and eight patients underwent open surgery. The median operative time was 162 min and estimated blood loss was 350mL. Ten patients had normal renal function and 12 patients had an initial increase in creatinine but improved gradually. Six patients developed acute renal failure; five patients gradually recovered in 5-32 days after temporary hemodialysis. Renal replacement therapy significantly correlated with maximal anterior-posterior diameter of the LRV (p = 0.001). Complications were observed in 11 cases, four of which were Clavien-Dindo grades I-II. Thirteen patients were alive with no recurrence, nine patients were alive with metastasis, and six cases died during the follow-up period. LRV ligation following en bloc resection of segmental IVC and right kidney is feasible, with no significant long-term impact on renal function. The maximum anterior-posterior diameter of the LRV is a reliable method for predicting renal replacement therapy in the absence of collateral circulation.

En Bloc Inferior Vena Cava (IVC) Resection Without Reconstruction With Right Hepatectomy and Right Nephrectomy for a Large IVC Leiomyosarcoma.

Radical resection remains the only potential cure in the management of inferior vena cava (IVC) leiomyosarcomas with multivisceral resections often needed (Borghi et al. in J Cardiovasc Surg (Torino) 63:649-663, 2022). This video describes the technical nuances of surgical resection of a large retrohepatic IVC leiomyosarcoma. Computed tomography of a 60-year-old woman revealed a 12 × 12 × 9.5 cm mass in the right suprarenal region infiltrating the IVC with intraluminal extension up to the hepatic venous confluence. The mass involved the right hepatic vein with infiltration of segment 7 of the liver and splaying of the right portal vein. Robust lumbar venous drainage from the infratumoral IVC was seen. En bloc IVC resection without reconstruction along with a right hepatectomy and right nephrectomy was performed via a right thoracoabdominal approach. After a Catell-Braasch maneuver, the surgery can be broadly divided into four major steps: (1) Right retroperitoneal mobilization of the tumor and right kidney with infratumoral IVC control, (2) mobilization of the right liver with suprahepatic IVC control, (3) division of the right portal structures with right hepatectomy, and (4) en bloc resection of the IVC tumor. Reconstruction of the IVC was not performed owing to the presence of venous collaterals (Langenbecks et al. in Arch Surg 407:1209-1216, 2022). Final histopathology showed a high-grade leiomyosarcoma with histologic organ invasion in the liver and right kidney with resected margins free of the tumor (R0). Meticulous preoperative planning and expertise in liver resection and retroperitoneal surgeries facilitates such radical yet safe multivisceral resection for a large retrohepatic IVC leiomyosarcoma without the need for a cardiopulmonary bypass.

Clinical outcomes after inferior vena cava resection for malignant disease. A single center experience of 51 vena cava resections

Background and objectiveFor tumors involving inferior vena cava (IVC), surgery with complete resection remains the first line treatment. Management of IVC after resection, either ligation without reconstruction or primary reconstruction, is debated. Our study aimed to evaluate type of venous reconstruction, anticoagulation management and morbidity. MethodsA French single center database of patients who underwent partial or total circumferencial resection of the IVC for malignant disease was analyzed. Inclusion criteria were any oncologic procedure for a retroperitoneal neoplasm requiring concomitant resection of the IVC with or without venous reconstruction with prosthesis. Exclusion criteria were surgery before year 2000. Data were descriptive and reverse Kaplan Meier was used for follow-up calculation. The endpoints were the rate of prosthetic reconstruction, the use of anticoagulation and the post-operative outcomes. ResultsFifty – one patients were included with a median duration of follow-up of 54.8 months. The majority of patients were men (56.9%). Median age of the population was 44.1 years. Most of the patients underwent surgery for primary testicular cancer and for sarcoma. Complete IVC resections were performed in 46 (90,2%) patients, 32 having a concomitant prosthetic replacement. Eight patients underwent aortic resection in the same operative time. Postoperative morbidity was 33.3%. Post-operative anticoagulation was done in 24 patients. At 1 month, four patients developed thrombosis in the prosthesis. ConclusionsIVC resections are feasible and safe. Venous reconstruction and postoperative management were planned according to the preoperative imaging and intraoperative findings. We propose a decision-tree for peri-operative management and anticoagulation.

Full-Circumference Prosthetic Grafts for Replacing a Retrohepatic Inferior Vena Cava Segment During Hepatectomy for Tumor.

Although hepatectomy including inferior vena cava (IVC) resection is becoming more common, some details remain uncertain such as use of artificial materials to replace a tumor-involved, damaged, or narrowed retrohepatic IVC segment. Surgical outcomes of 12 patients who underwent hepatectomy with IVC resection including reconstruction using synthetic tubular grafts were investigated to clarify safety and feasibility. Operative time (median, 573min; range, 268 to 774) and the blood loss (1076mL; 155 to 2960) were acceptable. In-hospital mortality was 8% (1/12), and morbidity was 42% (5/12). Among the 12 patients, 2 were planned to undergo IVC reconstruction without an artificial graft. In one patient, prosthetic repair was adopted because of massive bleeding from the IVC wall during dissection of tumor from the IVC. In the other, severe stricture became evident during attempted direct closure of the partially resected IVC wall. Ongoing experience has increased our acceptance of combined liver and IVC resection. We believe that segmental IVC resection and reconstruction with a prosthetic tubular graft could be chosen more frequently in managing liver tumors suspected to involve the IVC.

Extended pancreatoduodenectomy with portal vein and inferior vena cava resection and reconstruction combined with sorafenib for hepatoid carcinoma of the pancreas: a strategy of superextended surgery combined with targeted therapy.

Extended pancreatoduodenectomy with portal vein and inferior vena cava resection and reconstruction combined with sorafenib for hepatoid carcinoma of the pancreas: a strategy of superextended surgery combined with targeted therapy.

Surgery of Colorectal Liver Metastases Involving the Inferior Vena Cava: A Systematic Review.

Combined hepatic and inferior vena cava (IVC) resection is the only potentially curative treatment for patients with colorectal liver metastases (CRLM) involving the IVC. Most of the existing data come from case reports or small case series. In this paper, a systematic review based on the PICO strategy was performed in accordance with the PRISMA statement. Papers from January 1980 to December 2022 were searched in Embase, PubMed, and the Cochrane Library databases. Articles considered for inclusion had to present data on simultaneous liver and IVC resection for CRLM and report surgical and/or oncological outcomes. From a total of 1175 articles retrieved, 29, including a total of 188 patients, met the inclusion criteria. The mean age was 58.3 ± 10.8 years. The most frequent techniques used were right hepatectomy ± caudate lobe for hepatic resections (37.8%), lateral clamping (44.8%) for vascular control, and primary closure (56.8%) for IVC repair. The thirty-day mortality reached 4.6%. Tumour relapse was reported in 65.8% of the cases. The median overall survival (OS) was 34 months (with a confidence interval of 30-40 months), and the 1-year, 3-year, and 5-year OS were 71.4%, 19.8%, and 7.1%, respectively. In the absence of prospective randomized studies, which are difficult to perform, IVC resection seems to be safe and feasible.

V03-07 ROBOTIC INFERIOR VENA CAVA GRAFTING AND RECONSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023V03-07 ROBOTIC INFERIOR VENA CAVA GRAFTING AND RECONSTRUCTION Matthew Lee, Aeen Asghar, David Strauss, Naveen Krishnan, and Daniel Eun Matthew LeeMatthew Lee More articles by this author , Aeen AsgharAeen Asghar More articles by this author , David StraussDavid Strauss More articles by this author , Naveen KrishnanNaveen Krishnan More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003241.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although oncologic applications of the surgical robot have become commonplace, its true strength is showcased via complex reconstructive procedures, such as central vessel vascular reconstruction. We demonstrate two cases of inferior vena cava (IVC) robotic assisted laparoscopic (RAL) reconstruction using synthetic grafts. METHODS: First, we show a 78-year-old male with cT3b right renal mass undergoing RAL radical nephrectomy and IVC thrombectomy. After interaortocaval dissection, the right renal artery is divided and the left renal vein, suprarenal IVC, and infrarenal IVC are clamped. The mass invaded a 5-centimeter portion of the IVC, necessitating segmental IVC resection. A 6-centimeter PTFE interposition graft was anastomosed to the IVC to re-establish vascular continuity. Next, a 43-year-old female with an OptEaseTM IVC filter that had eroded through the IVC, deviating the right ureter, required IVC reconstruction. The IVC was clamped proximally and distally. A cavotomy was made and the filter was removed piecemeal. After anterior IVC excision, an 8-centimeter segment of PTFE graft was sutured to the defect as an onlay patch graft. RESULTS: IVC cross clamp time was 108 and 132 minutes, respectively. Length of stay was 6 and 5 days, respectively. Neither patient had any vascular based complications and were discharged home. CONCLUSIONS: We demonstrate that RAL management of complex IVC pathologies requiring IVC reconstruction with synthetic grafts may be safe, feasible, and effective. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e247 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Lee More articles by this author Aeen Asghar More articles by this author David Strauss More articles by this author Naveen Krishnan More articles by this author Daniel Eun More articles by this author Expand All Advertisement PDF downloadLoading ...

Outcomes of Arterial and Caval Resection During Post-Chemotherapy Retroperitoneal Lymph Node Dissection in Metastatic Testicular Cancer

Background/Objective:In the United States, testicular cancer is the most common solid tumor in men aged 15 to 34. Fortunately, testicular cancer has a cure rate greater than 90% and a 97% five-year survival rate. For the men not cured, a relapse to the retroperitoneum (RP) is most common. Of the patients with RP metastases, a minimal number may require post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) with resection of the aorta, external iliac, or inferior vena cava (IVC). We hypothesized this procedure would yield reasonable cure rates with acceptable levels of postoperative complications to warrant the indication for surgery.
 Methods:Between 2000 and 2020, 2,054 patients with metastatic testicular cancer underwent a PC-RPLND; of those men, 39 also underwent an aortic, external iliac, and/or IVC resection. For the men with a PC-RPLND and vascular resection, demographic, clinical, pathologic, and operative information were reviewed. Next, a Kaplan-Meier curve was created to determine overall survival
 Results:In this retrospective cohort study of 39 patients, PC-RPLND and vascular resection occurred at a median age of 40. The median follow-up of the cohort was 9 months. The median pre-operative mass size was 9 cm and 19 cm in the RP and pelvis, respectively. At PC-RPLND, 54%, 13%, 18%, and 15% of patients demonstrated cancer, teratoma, teratoma and cancer, and necrosis, respectively. Following PC-RPLND and vascular resection, 22 (56%) patients recurred. The median (IQR) time to relapse was 4.2 (2.5 – 8.2) months. Recurrence to the lung was most common, followed by the RP and liver. In total, 17 (44%) patients died of disease with a median overall survival of 14.8 months.
 Conclusion:With an overall survival rate of 45% at two years in this heavily pretreated patient population, PC-RPLND with resection of the aorta, external iliac, and/or IVC is reasonable in very select cases.

Resection of inferior vena cava, abdominal aorta, bilateral common iliac arteries, and bilateral partial external iliac arteries with artificial vessel replacement during radical endometrial cancer surgery: a case report

BackgroundEndometrial carcinoma (EC) is a common malignant tumor of the female reproductive system, often accompanied by lymph node metastasis. Artificial vascular implantation is a common surgical treatment for mediastinal tumors and abdominal aortic aneurysms but is rarely used in gynecological surgery.Case presentationA 54-year-old female patient was first admitted to the hospital in January 2018 due to “irregular vaginal bleeding over 3 months”. CT showed a mass in the uterine cavity, and several swollen lymph nodes in the retroperitoneum and pelvic cavity. The initial diagnosis was an endometrial malignant tumor. We performed radical endometrial cancer surgery with parallel resection of inferior vena cava, abdominal aorta, bilateral common iliac arteries, bilateral external iliac arteries, and artificial vessel replacement, which was successful, with good postoperative recovery and no lesion progression at 3 years postoperative follow-up.ConclusionThis is an early case of gynecological clinical use of prostheses. Through multidisciplinary cooperation, the surgical resection rate of patients with EC in radical surgery was improved without serious fatal complications and achieved a high long-term postoperative survival rate.

Left hepatectomy with suprahepatic inferior vena cava resection and reconstruction under veno-arterial extracorporeal membrane oxygenation for intrahepatic cholangiocarcinoma: a case report

BackgroundCurative surgery is the most effective treatment for intrahepatic cholangiocarcinoma (ICC). When an ICC involves the suprahepatic inferior vena cava (IVC), hepatectomy with suprahepatic IVC resection and reconstruction is challenging. For reconstruction of the suprahepatic IVC, total hepatic vascular exclusion (THVE), veno-venous bypass, and/or in situ hypothermic portal perfusion are required, but mortality and morbidity remain high.Case presentationWe present a 73-year-old woman with mass-forming ICC which invaded the suprahepatic IVC and middle hepatic vein. Left hepatectomy, suprahepatic IVC resection, and reconstruction with an artificial graft were successfully performed during veno-arterial extracorporeal membrane oxygenation (V-A ECMO) to maintain blood pressure. While clamping the IVC diagonally, the right hepatic vein confluence could be preserved. No congestion in the right liver was seen; therefore, there was no requirement for the Pringle maneuver or THVE during reconstruction. No morbidity or mortality was seen after surgery.ConclusionsHepatectomy with suprahepatic IVC resection and reconstruction under V-A ECMO can be performed safely. When an ICC invades the suprahepatic IVC, V-A ECMO during resection and reconstruction of the suprahepatic IVC with an artificial graft is recommended as one of the options.

Resection of retroperitoneal tumors with inferior vena cava involvement without caval reconstruction.

Retroperitoneal tumors with involvement of the inferior vena cava (IVC) often require resection of the IVC to achieve complete tumor removal. This study evaluates the safety and efficacy of IVC ligation without caval reconstruction. A retrospective chart review of patients who underwent IVC ligation(IVC-Ligation) and IVC resection with reconstruction (IVC-Reconstruction) at our institution between May 2004 and April 2021 was performed. Outcomes from the two surgical techniques were compared via univariate analysis using the Kruskal-Wallis test for continuous variables and Fisher's exact test for categorical variables. Forty-nineIVC-Ligation and sixIVC-Reconstruction surgeries were identified. There were no differences in baseline demographics, tumor characteristics, complication rates, postoperative morbidity, or overall 5-year survival between groups. IVC-Reconstruction patients were more likely to require intensive care unit admission (83% vs. 33%; p = 0.0257) and the IVC-Ligation cohort had a tendency to present with nondebilitating postoperative lymphedema (35% vs. 0%; p = 0.1615), which resolved for most patients. IVC-Ligation is a viable surgical option for select patients presenting with retroperitoneal tumors with IVC involvement and provides acceptable short- and medium-term outcomes.

Characterizing Tumor Thrombus Arising from Non–Clear Cell Renal Cell Carcinoma

BackgroundRenal cell carcinoma (RCC) can exhibit a unique vascular tropism that enables tumor thrombus extension into the inferior vena cava (IVC). While most RCC subtypes that form tumor thrombi are of clear cell (cc) histology, non–clear cell (ncc) subtypes can also exhibit this unique growth pattern. ObjectiveTo characterize clinicopathologic differences and survival outcomes among patients with IVC tumor thrombus arising from ccRCC versus nccRCC. Design, setting, and participantsPatients diagnosed with IVC tumor thrombus secondary to RCC in our institutional experience from 2003 to 2021 were identified. Outcome measurements and statistical analysisClinicopathologic characteristics were compared by histology. Perioperative and oncologic outcomes including recurrence-free (RFS), overall (OS), and cancer-specific (CSS) survival were assessed using multivariable Cox regression analyses. Results and limitationsThe analyzed cohort included 103 patients (82 ccRCC and 21 nccRCC). There were no significant differences in baseline demographic parameters. Patients with nccRCC were more likely to have regional lymph node involvement (42.9% vs 20.7%, p = 0.037). No differences in perioperative outcomes, IVC resection, or IVC reconstruction were observed between groups. The median follow-up time was 30 mo. The median RFS was 30 (nccRCC) versus 53 (ccRCC) mo (p = 0.1). There was no significant difference in OS or CSS. This study was limited by its small sample size. ConclusionsPatients with IVC tumor thrombus arising from ccRCC and nccRCC exhibit similar perioperative and oncologic outcomes. While surgical appropriateness was not impacted by histologic subtype, multimodal strategies are needed to improve outcomes for patients with tumor thrombus. Patient summaryRenal cell carcinoma (RCC) can uniquely invade vasculature and form a tumor thrombus. This study examined the difference in outcomes of patients with tumor thrombus based on RCC subtype (clear cell vs non–clear cell). We found that patients exhibited similar surgical and survival outcomes regardless of RCC type.

Oncological liver resection in elderly – A retrospective comparative study

BackgroundDue to demographic changes and higher life expectancy especially in industrial nations, the number of liver resections in patients ≥70 years is rising. It is known that older age is associated with higher postoperative morbidity and mortality after surgery under general anesthesia. The aim of this analysis is to compare the postoperative outcome after liver resections for malignancies in patients aged below and above 70 years. Materials and methodsA prospectively collected electronic database of 1034 liver resections between January 2013 and December 2019 was retrospectively analyzed. Comparative analysis of patients <70 and ≥ 70 years receiving liver resections for malignancies included 889 operations in 703 patients. Analysis of postoperative outcome and uni- and multivariate analyses of associated risk factors were performed. ResultsMedian age of the whole cohort was 65 years (range 18–87 years). N = 582 liver resections (65.7%) were performed in patients <70 years with 42.8% major hepatectomies and n = 307 (34.3%) liver resections in patients ≥70 years with 50.5% major hepatectomies (p = 0.034). Relevant postoperative morbidity of the whole cohort was 27.9%. The 30-day mortality was 3.9% and re-operation rate 14.8%. Patients ≥70 years had significantly higher postoperative morbidity and mortality rates than patients <70 years. Major resections, longer operating time, need of intraoperative transfusions of blood products as well as biliodigestive anastomosis (BDA) and inferior vena cava (IVC) resection were independent risk factors for worse postoperative outcome. ConclusionLiver resections in patients ≥70 years are associated with a worse postoperative course after. Parenchyma sparing resections should be preferred in those patients.

Robot-Assisted Laparoscopic IVC Treatment Strategy in Retroperitoneal Tumors.

ObjectivesTo show the practice of robot-assisted laparoscopic inferior vena cava (IVC) treatment strategies in patients with retroperitoneal tumors.Patients and MethodsFrom October 2020 to July 2021, 17 patients with retroperitoneal tumors successfully underwent robot-assisted laparoscopic tumor resection with IVC management. The patient details, tumor characteristics, intraoperative data, pathological features and severe complications were assessed. The IVC treatment strategies were divided into 4 ways: ①local resection and primary repair of the IVC; ②IVC ligation; ③ IVC reconstruction by bovine pericardial grafts; and ④ IVC transection and anastomosis.ResultsIn terms of IVC management, 5 cases had conventional total occlusion of the IVC and its branches, 3 cases had delayed occlusion of the proximal IVC technique, 2 cases had IVC resection by Satinsky clamp, 5 cases had IVC ligation, 1 case had IVC reconstruction by bovine pericardial grafts and 1 case had IVC transection and anastomosis. The median operation time was 151 min, and blood loss was 500 ml. There was no severe complication perioperatively. The follow-up time of 17 patients was 8 to 17 months (median: 12 months). No local recurrence or overall death was found during follow-up.ConclusionsThese robot-assisted laparoscopic IVC treatment strategies were considered to be safe and feasible in experienced centers, as well as helpful to completely remove the tumor for better oncological prognosis and restore the blood reflux of IVC as much as possible to ensure fewer postoperative complications.

Liver transplant program at Botkin Hospital. Experience of 100 surgeries

Objective: to present an analysis of the results of 100 cadaveric liver transplants performed at Botkin Hospital from July 2018 to October 2021. Materials and methods. From July 2018 to October 2021, 100 orthotopic liver transplantation (LTx) from a deceased donor were performed at the surgical clinic of Botkin Hospital. The recipients were 58 males (58%) and 42 females (42%). The mean age of the recipients was 48.73 ± 8.56 (24–66) years, while their mean MELD was 19.54 ± 4.35 (15–33). The main indications for LTx were cirrhosis resulting from chronic viral hepatitis (CVH) C (52%), nutritional-toxic cirrhosis (20%), autoimmune liver and bile duct disease (18%), CVH B (7%), and hepatocellular carcinoma (HCC) (3%). During the period under study, 119 potential liver transplant donors were evaluated. The mean age of the donors was 44.2 ± 11.12 (21–63) years. Median levels of sodium, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin were 141 (138–146) mmol/L, 27 (20.7–47.4) units/L, 25 (17–41.5) units/L, and 9.65 (6.42–13.7) μmol/L, respectively. The median graft hepatic steatosis was 10% (5–15). LTx was performed using the piggyback technique (99/100 cases) and classic technique with inferior vena cava resection (1/100). End-to-end porto-portal vein anastomosis was performed (99/100 cases). Anastomosis of the donor organ’s portal vein with the recipient’s left gastric vein due to occlusive thrombosis of the recipient’s portal vein was carried out (1/100). In all cases, a continuous end-to-end arterial anastomosis was formed. End-to-end choledochocholedochal anastomotic strictures (95/100) and end-to-side hepaticojejunostomy (5/100) were formed. Results. Median cold ischemia time was 312.5 minutes (280–380). Mean operative time was 488.91 ± 65.34 (95% CI: 475.9–501.9) minutes, median intraoperative blood loss was 1000 (600–1500) mL. Thirty-day mortality was 2% (Clavien–Dindo class V). Early postoperative complications (Clavien–Dindo class IIIa–IVa) developed in 12/100 patients (12%). Graft arterial thrombosis occurred in 3 cases (3%), biliary anastomotic strictures in 6 (6%), and subhepatic hematoma in 2 (2%). The average intensive care unit (ICU) bed day was 2.34 ± 1.67 (1–8). Total postoperative bed-day was 14.63 ± 5.35 (10–39). During case follow-up, a prolonged form of calcineurin inhibitor (CNI) was administered as immunosuppressive therapy in mono regimen (85 patients), in combination with mycophenolic acid derivatives (7), and in combination with everolimus (6). Of the 93 patients, 46 patients (49.46%) had the new coronavirus infection (COVID-19) before or after transplantation; in no case did COVID-19 lead to death. Six patients (13.04%) were hospitalized due to COVID-19. To date, 33/93 (25.48%) patients have been vaccinated, resulting in 75 (75%) liver transplant recipients immune to COVID-19. The overall 1-year survival rate was 95% and the 3-year survival rate was 91%. Conclusion. Introduction of LTx in multidisciplinary hospitals allows to, already at the start of the program, achieve immediate and long-term treatment outcomes (in decompensated diffuse liver disease) that are comparable to those of leading transplantation centers.

Efficacy of preoperative cine magnetic resonance imaging in evaluation of adhesion of renal cancer thrombus to inferior vena cava wall

ObjectiveIn renal cell carcinoma with inferior vena cava (IVC) thrombus, adhesion to, or invasion into, the IVC wall will often increase the level of surgical difficulty and even necessitate resection of the IVC. It will generally be difficult to perform an accurate preoperative assessment using the standard imaging modalities of contrast-enhanced computed tomography and standard magnetic resonance imaging (MRI). Cine MRI is an MRI sequence that captures motion to produce detailed information on both the anatomy and the dynamic motion. In the present study, we evaluated the accuracy of preoperative cine MRI for determining the need for IVC wall resection, with validation of the imaging findings according to the intraoperative findings. MethodsA total of 15 patients who had undergone radical nephrectomy and tumor thrombectomy from May 2018 to April 2020 met the inclusion criteria. The primary outcome of interest was the need for IVC resection because of adhesion or invasion of a venous tumor thrombus. Cine MRI was used to evaluate the blood flow between the tumor thrombus and the IVC wall and the presence of tumor thrombus mobility during free respiration. The sensitivity and specificity were calculated for preoperative cine MRI for determining the need for IVC wall resection. The Fisher exact test was used to determine the association between intraoperative IVC wall resection and the cine MRI findings. Furthermore, receiver operating characteristic curves and the area under the curve were used to compare the accuracy of conventional MRI and cine MRI. ResultsOf the 15 patients, 8 (53.3%) had undergone IVC resection. We found that the absence of both dynamic blood flow and tumor thrombus mobility on cine MRI could reliably predict for IVC resection with 100% (95% confidence interval, 51.8%-100%) sensitivity and 85.7% (95% confidence interval, 42.1%-1.00%) specificity. The area under the receiver operating characteristic curve was 0.821 for conventional MRI and 0.929 for cine MRI. ConclusionsIn the preoperative setting, cine MRI could be a helpful examination modality to predict for the need for IVC wall resection for patients with renal cell carcinoma with venous tumor thrombus.

Leiomyosarcoma of inferior vena cava (IVC): do we really need to reconstruct IVC post resection? Single institution experience.

Inferior vena cava (IVC) leiomyosarcomas (LMS) are a rare group of retroperitoneal tumors. R0 surgical resection is the only curative modality of treatment. IVC resection for retroperitoneal sarcoma is a complex surgery with no definitive guidelines for reconstruction. Retrospective review of all patients who underwent surgical resection of primary leiomyosarcoma of the IVC requiring resection from 2010 to 2020 at our tertiary care center was performed. Among 24 patients who required IVC resection for LMS, only 7 (29%) required reconstruction of IVC. According to Clavien-Dindo classification, there was one grade 3 or more morbidity and 1 post-operative mortality. Seventeen patients underwent R0 resection whereas 7 patients had R1 resection on final histopathology. At a median follow-up of 25months (range 8-91months), the median OS was 40months with median DFS of 28months. Two patients presented with local recurrence while 13 patients developed systemic recurrence on follow-up. Careful preoperative multidisciplinary planning can make IVC resection without reconstruction feasible with acceptable perioperative morbidity, mortality, and oncological outcomes for IVC LMS.

SURGICAL TECHNIQUE IN LEIOMYOSARCOMA OF THE INFERIOR VENA CAVA DEPENDING ON ITS LOCATION

The aim: To improve the outcomes of inferior vena cava (IVC) leiomyosarcoma, propose own classification of IVC segments, which correlates with surgical access, methodology, sequence and amount of surgery. Materials and methods: In the period from 1991 to 2021 in the Transcarpathian Regional Clinical Hospital named after A. Novak and in the Transcarpathian Antitumor Center 8 patients with IVC leiomyosarcoma were operated. The prevalence of leiomyosarcoma in IVC was determined according to the division of IVC into 7 segments. Defeat of one segment of IVC was in 50% of cases, two - in 37.5%, three - in 12.5%. In 5 (62.5%) cases circular resection and alloprosthesis of IVC were performed; in 2 (25%) – circular resection, alloprosthesis of IVC and implantation of the right and left renal veins in the prosthesis; in 1 (12.5%) - circular resection, alloprosthesis of IVC and implantation of the left renal vein in the prosthesis. All surgeries were performed with laparotomy access (87.5% by Chevron type). Results: The average operation time was 215 (160-320) minutes, the average blood loss was 305 (250-500) ml. Postoperative complications were recorded in 2 (25%) cases. There were no cases of pulmonary embolism, venous thrombosis, prosthesis thrombosis, perioperative mortality. In 7 (87.5%) cases, surgery was radical. The overall 1-year, 2-year and 3-year survival rates were 87.5%, 71.4% and 57.7%. Conclusions: The division of IVC into 7 segments characterizes the detailed definition of the cranial limit of leiomyosarcoma and segmental involvement of IVC in the tumor process, which allows to choose the right surgical tactics, perform radical resection of IVC and maintain laminar blood flow to IVC and its tributaries.

SURGICAL TECHNIQUE IN LEIOMYOSARCOMA OF THE INFERIOR VENA CAVA DEPENDING ON ITS LOCATION.

The aim: To improve the outcomes of inferior vena cava (IVC) leiomyosarcoma, propose own classification of IVC segments, which correlates with surgical access, methodology, sequence and amount of surgery. Materials and methods: In the period from 1991 to 2021 in the Transcarpathian Regional Clinical Hospital named after A. Novak and in the Transcarpathian Antitumor Center 8 patients with IVC leiomyosarcoma were operated. The prevalence of leiomyosarcoma in IVC was determined according to the division of IVC into 7 segments. Defeat of one segment of IVC was in 50% of cases, two - in 37.5%, three - in 12.5%. In 5 (62.5%) cases circular resection and alloprosthesis of IVC were performed; in 2 (25%) - circular resection, alloprosthesis of IVC and implantation of the right and left renal veins in the prosthesis; in 1 (12.5%) - circular resection, alloprosthesis of IVC and implantation of the left renal vein in the prosthesis. All surgeries were performed with laparotomy access (87.5% by Chevron type). Results: The average operation time was 215 (160-320) minutes, the average blood loss was 305 (250-500) ml. Postoperative complications were recorded in 2 (25%) cases. There were no cases of pulmonary embolism, venous thrombosis, prosthesis thrombosis, perioperative mortality. In 7 (87.5%) cases, surgery was radical. The overall 1-year, 2-year and 3-year survival rates were 87.5%, 71.4% and 57.7%. Conclusions: The division of IVC into 7 segments characterizes the detailed definition of the cranial limit of leiomyosarcoma and segmental involvement of IVC in the tumor process, which allows to choose the right surgical tactics, perform radical resection of IVC and maintain laminar blood flow to IVC and its tributaries.

Nephrectomy with resection and replacement of inferior vena cava in a 1-year-old patient with nephroblastoma of the left kidney and thrombosis of inferior vena cava and right atrium

<h3></h3> Опухолевый тромбоз нижней полой вены и правого предсердия считают редким осложнением в детской солидной онкологии. Лечение таких пациентов сопряжено с высокими рисками осложнений и неблагоприятного исхода, что требует мультидисциплинарного подхода и использования высокотехнологичного оборудования на всех этапах комбинированного или комплексного лечения. На сегодняшний день не решен ряд вопросов, касающихся деталей оперативного вмешательства, подготовки пациентов к хирургическому лечению и наблюдения в послеоперационном периоде. В статье описан случай успешного хирургического лечения пациентки с нефробластомой левой почки и опухолевым тромбозом нижней полой вены и правого предсердия, а также представлен обзор актуальной литературы.