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Feasibility and Outcome of Inferior Vena Cava Resection for Hepatobiliary and Retroperitoneal Malignancies
*Caroline J Simon, *Mohamed E Akoad, James J Pomposelli, W David Lewis, *Khalid O Khwaja, Elizabeth A Pomfret, Roger L Jenkins Lahey Clinic, Burlington, MA
Objective: Tumors involving the inferior vena cava (IVC) are often considered unresectable with poor outcomes. The aim of this study is to assess the outcomes of IVC resection for hepatobiliary and retroperitoneal maligancies. Design: Single-center retrospective review. Setting: Tertiary referral university medical center. Patients: Six patients (one male, five female) with diagnoses including cholangiocarcinoma (n = 3), primary IVC sarcoma (n = 2), and metastatic anal carcinoma (n = 1). Average patient age at operation was 43.3 years (range 33 to 52 years). Average tumor size was 10.3 cm (range 7 to 12 cm). Interventions: Suprarenal and/or infrarenal IVC resection, in conjunction with major hepatic resection and en-bloc partial diaphragm resection where necessary to achieve R0 or R1 resections. Veno-veno bypass was instituted where appropriate prior to IVC resection. Segment of resected IVC was reconstructed with a synthetic tube graft. Main Outcome Measures: Postoperative patient and disease-free survival. Results: Survival was best in the two patients with IVC sarcoma primaries; both are currently alive and disease-free (3 years and 11 years post resection). Average survival for the three patients with cholangiocarcinoma primaries was 22 months (range 11 to 33 months). Survival in the patient with metastatic anal carcinoma was 22 months. Patients with cholangiocarcinoma and metastatic anal carcinoma had evidence of disease progression at the time of death. Average length of inpatient stay was 13.8 days (range 5 to 31 days). Conclusions: IVC resection with tube graft reconstruction is technically possible and would offer selected patients a chance for long-term survival. Patient survival is dependent on achieving an R0 resection and tumor biology. Major vascular invasion should not be an absolute contraindication to surgical resection.
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