• Lior Orbach, Ido Nachmany, Yaacov Goykhman, Guy Lahat, Ofer Yossepowitch, Avi Beri, Yanai Ben-Gal, Joseph M Klausner, and Nir Lubezky.
• Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
• Isr Med Assoc J. 2020 Jun 1; 22 (6): 364-368.

BackgroundAbdominal tumors invading the inferior vena cava (IVC) present significant challenges to surgeons and oncologists.ObjectivesTo describe a surgical approach and patient outcomes.MethodsThe authors conducted a retrospective analysis of surgically resected tumors with IVC involvement by direct tumor encasement or intravascular tumor growth. Patients were classified according to level of IVC involvement, presence of intravascular tumor thrombus, and presence of hepatic parenchymal involvement.ResultsStudy patients presented with leiomyosarcomas (n=5), renal cell carcinoma (n=7), hepatocellular carcinoma (n=1), cholangiocarcinoma (n=2), Wilms tumor (n=1), neuroblastoma (n=1), endometrial leiomyomatosis (n=1), adrenocortical carcinoma (n=1), and paraganglioma (n=1). The surgeries were conducted between 2010 and 2019. Extension of tumor thrombus above the hepatic veins required a venovenous bypass (n=3) or a full cardiac bypass (n=1). Hepatic parenchymal involvement required total hepatic vascular isolation with in situ hepatic perfusion and cooling (n=3). Circular resection of IVC was performed in five cases. Six patients had early postoperative complications, and the 90-day mortality rate was 10%. Twelve patients were alive, and six were disease-free after a mean follow-up of 1.6 years.ConclusionsSurgical resection of abdominal tumors with IVC involvement can be performed in selected patients with acceptable morbidity and mortality. Careful patient selection, and multidisciplinary involvement in preoperative planning are key for optimal outcome.

25 keywords...

hide…