Resection of the inferior vena cava without reconstruction for urologic malignancies
Brian Duty1, Siamak Daneshmand
1Section of Urologic Oncology, Division of Urology & Renal Transplantation, Oregon Health & Science University, Portland, Oregon, USA.
Objectives:
To present our experience with inferior vena cava (IVC) resection in 6 patients. Complete surgical excision of tumors within the retroperitoneum may afford patients their best chance at long-term disease-free survival. In rare instances, surgical therapy may require resection of the IVC.
Methods:
Between 2005 and 2008, a total of 6 patients underwent caval resection. The median age of the patients was 47 years (range 26-66 years). Three patients had metastatic germ cell tumors within the retroperitoneum and underwent postchemotherapy retroperitoneal lymph node dissection. Two patients had transitional cell carcinoma and 1 had renal cell carcinoma of the right kidney, which were treated by radical nephrectomy. The infrarenal IVC was removed in 5 patients and the infrahepatic cava in the remaining patient. The IVC was not reconstructed in any patient.
Results:
Mean length of stay was 10 days (range 7-17 days). Five complications were noted in 2 patients. Complications included pneumothorax, lower-extremity compartment syndrome, right upper-extremity brachial plexus stretch injury, and respiratory failure in 1 patient and atrial fibrillation in another. No complications occurred in the remaining patients. Chronic lower extremity edema was not encountered in any patient. At present, all 3 patients with testicular cancer are disease-free. Of the 3 patients with kidney cancer, 2 died of disease progression and the remaining patient has metastatic disease.
Conclusions:
IVC resection without reconstruction is well tolerated in patients with large retroperitoneal masses because most patients have well-established collaterals before surgery due to pre-existing caval obstruction. Multiple variables have been correlated with improved prognosis in cancer patients. One of the factors most important to surgical oncologists is complete tumor resection at the time of initial extirpative surgery. Complete excision of tumors within the retroperitoneum may require resection of major vascular structures, including the IVC.
