Techniques for inferior vena cava resection and reconstruction for retroperitoneal tumor excision

Management of the inferior vena cava (IVC) after resection for treatment of retroperitoneal sarcomas is controversial. Ligation is well tolerated if collateral circulation is preserved. These pathways, however, are often interrupted or resected during tumor excision, and up to 50% of these patients will experience lower extremity edema with IVC ligation. We have favored IVC reconstruction, particularly when circumferential resection is necessary for complete retroperitoneal tumor removal. Our results with this approach have been recently updated, documenting that en bloc resection and reconstruction of the IVC can be performed with very low morbidity and mortality and is associated with a low incidence of postoperative symptoms of venous hypertension. This article describes our preferred techniques for the management of the IVC after partial or circumferential resection.