Retroperitoneal tumors with vena caval extension: a multidisciplinary approach

Area of Science:

• Surgical Oncology
• Cardiovascular Surgery
• Abdominal Surgery

Background:

• Retroperitoneal tumors invading the inferior vena cava (IVC) present significant surgical challenges.
• Complete tumor resection is crucial for improving survival in these cases.
• Advanced surgical techniques, including cardiopulmonary bypass (CPB) and hypothermic circulatory arrest (HCA), may be necessary.

Purpose of the Study:

• To evaluate the feasibility and outcomes of complete resection for retroperitoneal tumors with IVC or right atrial involvement.
• To describe the multidisciplinary approach and surgical techniques employed.

Main Methods:

• Review of eight patients undergoing complete resection of retroperitoneal tumors with IVC/right atrial involvement since 1985.
• Preoperative imaging included IV pyelography, CT scans, renal arteriography, and IVC venography/MRI.
• Surgical approach involved combined median sternotomy and laparotomy with control of the intrapericardial IVC.

Main Results:

• Complete resection was technically feasible for all eight patients.
• Surgical management included IVC tumor thrombectomy using vascular occlusion, CPB, or CPB with HCA.
• The procedure demonstrated acceptable morbidity and mortality rates.

Conclusions:

• Complete resection of retroperitoneal tumors with IVC extension can significantly improve patient survival.
• A multidisciplinary team approach is essential for optimal management of these complex cases.
• The described surgical techniques are effective for achieving radical tumor resection.