Vladov Nikola, Kostadinov Radoslav, Mihaylov Vassil, Takorov Ivelin, Lukanova Tsonka, Yakova Maria, Trichkov Tsvetan, Odisseeva Evelina, Mutafchiyski Ventsislav
Clinic of HPB Surgery and Liver Transplantation, Military Medical Academy, 3 Georgi Sofiiski Street, Sofia, 1606, Bulgaria.
First Clinic of Abdominal Surgery, Military Medical Academy, 3 Georgi Sofiiski Street, Sofia, 1606, Bulgaria.
World J Surg. 2021 Jul;45(7):2270-2279. doi: 10.1007/s00268-021-06048-w. Epub 2021 Mar 16.
Tumours involving the supra-renal segment of IVC have dismal prognosis if left untreated. Currently, aggressive surgical management is the only potentially curative treatment but is associated with relatively high morbidity and mortality. This study aims to evaluate perioperative factors, associated with adverse postoperative outcomes, based on the perioperative characteristics and type of IVC reconstruction.
We identified 44 consecutive patients, who underwent supra-renal IVC resection with a mean age of 57.3 years. Isolated resection of IVC was performed in four patients, concomitant liver resection was performed in 27 patients and other associated resection in 13 patients. Total vascular exclusion was applied in 21 patients, isolated IVC occlusion in 11 patients. Neither venovenous bypass (VVB) nor hypothermic perfusion was used in any of the cases.
The mean operative time was 205 min (150-324 min) and the mean estimated blood loss was 755 ml (230-4500 ml). Overall morbidity was 59% and major complications (Dindo-Clavien ≥ III) occurred in 11 patients (25%). The 90-day mortality was 11% (5pts). Intraoperative haemotransfusion was significantly associated with postoperative general complications (p < 0,001). With a mean follow-up of 26.2 months, the actuarial 1-, 3- and 5-year survival is 69%, 34%, and 16%, respectively.
IVC resection and reconstruction in the aspect of aggressive surgical management of malignant disease confers a survival advantage in patients, often considered unresectable. When performed in experienced centres it is associated with acceptable morbidity and mortality.
累及下腔静脉肾上段的肿瘤若不治疗，预后很差。目前，积极的手术治疗是唯一可能治愈的方法，但会伴有相对较高的发病率和死亡率。本研究旨在根据围手术期特征和下腔静脉重建类型，评估与术后不良结局相关的围手术期因素。
我们纳入了44例连续接受肾上段下腔静脉切除术的患者，平均年龄57.3岁。4例患者行单纯下腔静脉切除术，27例患者行联合肝切除术，13例患者行其他相关切除术。21例患者采用全血管阻断，11例患者采用单纯下腔静脉阻断。所有病例均未使用静脉-静脉转流（VVB）或低温灌注。
平均手术时间为205分钟（150 - 324分钟），平均估计失血量为755毫升（230 - 4500毫升）。总体发病率为59%，11例患者（25%）发生主要并发症（Dindo-Clavien≥III级）。90天死亡率为11%（5例）。术中输血与术后全身并发症显著相关（p < 0.001）。平均随访26.2个月，1年、3年和5年的精算生存率分别为69%、34%和16%。
在恶性疾病的积极手术治疗中，下腔静脉切除和重建为通常被认为无法切除的患者带来了生存优势。在经验丰富的中心进行时，其发病率和死亡率是可接受的。
