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Vena cava replacement for malignant disease: is there a role?
T C Bower1, D M Nagorney, B J Toomey
1Department of Surgery, Mayo Clinic and Foundation, Rochester, Minn. 55905.
Annals of Vascular Surgery
|January 1, 1993
Summary
Vena cava reconstruction using grafts for cancer is a rare but safe procedure. It offers a potential solution for tumor control with few graft complications, even in advanced stages.
Area of Science:
- Vascular Surgery
- Surgical Oncology
- Oncology
Background:
- Malignant disease involving the vena cava often presents at advanced stages, making surgical intervention rare.
- Vena cava resection and graft replacement are seldom performed due to tumor stage and technical challenges.
Purpose of the Study:
- To evaluate the safety and efficacy of vena cava reconstruction for malignant disease.
- To assess graft patency, complications, and oncological outcomes in patients undergoing vena cava replacement.
Main Methods:
- Selective caval replacement in 11 patients (3 superior vena cava reconstruction, 8 inferior vena cava replacement) alongside tumor resection.
- Use of expanded polytetrafluoroethylene grafts for most reconstructions, with one spiral saphenous vein graft.
- Inclusion of major liver resections in six inferior vena cava replacement cases.
Main Results:
- No operative deaths; four patients experienced complications (bleeding, myocardial infarction, wound infection).
- No perioperative graft occlusions; one late superior vena cava reconstruction graft occlusion occurred.
- All inferior vena cava replacement grafts remained patent; eight of nine survivors had excellent performance status.
Conclusions:
- Vena cava reconstruction for malignancy can be performed safely with minimal graft-related issues.
- This procedure may provide the sole opportunity for tumor control in select patients with advanced malignancy.
- Long-term oncological outcomes require further investigation, but functional status in survivors is promising.