title: Liver resection combined with excision of vena cava.
abstract: BACKGROUND
  This study was designed to review our experience with combined partial hepatectomy and vena caval replacement for primary and metastatic liver tumors.
  
  
  METHODS
  The medical records of all the patients who underwent liver resection and excision of the vena cava over a period of 13 years and 4 months at a single institution were analyzed. The types of tumors fell into four categories: 1) metastatic, 2) primary leiomyosarcoma of the inferior vena cava, 3) tumors with direct extension to the liver, and 4) cholangiocarcinoma.
  
  
  RESULTS
  The perioperative mortality was 11% related to technical complications and hepatic insufficiency. Other important complications included biliary fistula and liver abscess; patients recovered from these complications without sequelae. Six of nine patients are alive with a followup from 6 months to 156 months (median 66.5 months), and three of them are free of disease. The most common sites of recurrence were lung, liver, and brain. The patients with leiomyosarcoma of the cava and pheochromocytoma who underwent these combined procedures had the longest survival.
  
  
  CONCLUSIONS
  This small series confirms the feasibility of obtaining longterm survival after excision of tumors that have involved portions of the liver and the vena cava. Innovative variations on the method of vena caval replacement and increased awareness of these complex surgical techniques will expand the indications of hepatic resection.
authors.affiliation: Department of Surgery, Thomas E Starzl Transplantation Institute, University of Pittsburgh, PA 15213, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Madariaga
authors.forename: J
authors.initials: J
authors.lastname: Fung
authors.forename: J
authors.initials: J
authors.lastname: Gutierrez
authors.forename: J
authors.initials: J
authors.lastname: Bueno
authors.forename: S
authors.initials: S
authors.lastname: Iwatsuki
mesh_terms: D000328:Adult; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D018281:Cholangiocarcinoma / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007890:Leiomyosarcoma / Q000601:surgery; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019043:Vascular Neoplasms / Q000601:surgery*; D014684:Venae Cavae / Q000601:surgery*