Department of Thoracic and Vascular Surgery and Lung and Heart-Lung Transplantation, Marie Lannelongue Hospital, 133 avenue de la Résistance, 92350, Le Plessis Robinson, France.
Department of Hepatobiliary Surgery, Paul Brousse Hospital, Villejuif, France.
World J Surg. 2021 Oct;45(10):3174-3182. doi: 10.1007/s00268-021-06227-9. Epub 2021 Jul 3.
Our aim was to describe the results of our program of surgical resection of tumors invading the inferior vena cava (IVC) at the hepatic and thoracic levels. We hypothesized that similar surgical outcomes may be obtained compared to tumor resection below the hepatic vein level if the liver function was preserved.
We performed a single-center retrospective study of 72 consecutive patients who underwent surgical resection from 1996 to 2019 for tumors invading the IVC. We compared two groups based on tumor location below (group I/II) or above (group III/IV) the inferior limit of hepatic veins.
Tumor histology was similarly distributed between groups. In group III/IV (n = 35), sterno-laparotomy was used in 83% of patients, cardiopulmonary bypass in 77%, and deep hypothermic circulatory arrest in 17%; 23% underwent liver resection. Corresponding proportions in group I/II were 3%, 0%, 0%, and 8%. In group III/IV, 4 patients required emergency resection. Mortality on day 30 was 17% (n = 6) in group III/IV and 0% in group I/II (P = 0.01). There was no liver failure among the 66 postoperative survivors and 5 out of 6 patients who died postoperatively presented a preoperative or postoperative liver failure (P < 0.001). Overall survival was not significantly different between groups with a median follow-up of 15.1 months. R0 resection was achieved in 66% of group I/II and 49% of group III/IV patients (P = 0.03).
Surgical resection of tumors invading the inferior vena cava at hepatic vein and thoracic levels should be reserved to carefully selected patients without preoperative liver failure to minimize postoperative mortality.
本研究旨在描述我们对侵犯肝静脉和胸段下腔静脉（IVC）的肿瘤进行手术切除的结果。我们假设，如果肝功能得到保留，那么在肝静脉以下水平进行肿瘤切除，可能会获得类似的手术结果。
我们对 1996 年至 2019 年期间因 IVC 受侵而行手术切除的 72 例连续患者进行了单中心回顾性研究。我们根据肿瘤位于肝静脉下方（I/II 组）或上方（III/IV 组）将两组进行比较。
两组肿瘤组织学分布相似。在 III/IV 组（n = 35）中，83%的患者采用了开胸剖腹术，77%的患者采用了体外循环，17%的患者采用了深低温停循环；23%的患者进行了肝切除。相应的比例在 I/II 组分别为 3%、0%、0%和 8%。在 III/IV 组中，有 4 例患者需要紧急切除。III/IV 组术后 30 天死亡率为 17%（n = 6），I/II 组为 0%（P = 0.01）。在 66 例术后存活者中无肝功能衰竭，6 例术后死亡患者中有 5 例术前或术后出现肝功能衰竭（P < 0.001）。在中位随访 15.1 个月后，两组的总体生存率无显著差异。I/II 组的 R0 切除率为 66%，III/IV 组为 49%（P = 0.03）。
对于没有术前肝功能衰竭的精心选择的患者，应保留肝静脉和胸段下腔静脉受侵肿瘤的手术切除，以最大限度地降低术后死亡率。
