Resection of the suprarenal inferior vena cava. The role of prosthetic replacement.

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.