Resection of the suprarenal inferior vena cava. The role of prosthetic replacement
C. Huguet, M. Ferri and A. Gavelli
Department of Surgery, Princess Grace Hospital, Monaco, Principality of Monaco.
OBJECTIVE: To review the role of prosthetic replacement after resection of
the suprarenal portion of the inferior vena cava (IVC). DESIGN:
Retrospective review of a series of six patients with malignant
infiltration of the suprarenal IVC undergoing operation in the last 11
years. SETTING: Multispecialty referral center. PATIENTS: One primary
leiomyosarcoma and five involvements of the IVC by liver carcinoma (n = 2),
adrenal carcinoma (n = 2), and recurrent renal carcinoma (n = 1).
INTERVENTIONS: En bloc resection of the tumor with the IVC under total
vascular exclusion of the liver in four cases, combined major liver
resection in four cases, venous resection including the renal confluence in
four cases, prosthetic venous replacement in four cases, and no venous
replacement in two cases. MAIN OUTCOME MEASURES: Mortality, venous patency,
clinical assessment, and malignant recurrence. RESULTS: One postoperative
death (renal failure) following extended resection with right nephrectomy
and ligature of the left renal vein. Graft patency was controlled in
survivors, with good functional result. Among two patients without venous
replacement, one with complete caval obstruction and marked collateral
circulation has had a good result, and one with partial caval obstruction
experienced transient symptoms of venous insufficiency. Malignant
recurrence led to death in four patients (4, 6, 37, and 42 months after
surgery). CONCLUSIONS: Suprarenal IVC reconstruction is justified in
selected cases, with good functional results. When the renal confluence is
resected along with the IVC, renal vein reconstruction may be needed to
avoid acute renal failure. The oncologic results of such extensive
resections are poor. Adjuvant therapy should be evaluated.
