title: Hepatic resection for primary or secondary malignancies with involvement of the inferior vena cava: is this operation safe or hazardous?
abstract: BACKGROUND
  This study evaluated surgical techniques and results of patients with tumors who had undergone liver resection with partial resection and reconstruction of the IVC.
  
  
  METHODS
  We performed a retrospective analysis of all patients who underwent combined liver and IVC resection and reconstruction at a single institution. We identified 19 patients and two categories of tumors, primary (n = 8) and metastatic (n = 11). In 12 patients, a direct suture of the IVC was performed; in 3 patients a pericardium bovine patch was applied; in another 4 patients the IVC was replaced by PTFEt prosthesis. In nine patients, total hepatic vascular occlusion was required.
  
  
  RESULTS
  Perioperative mortality was 5.9%, related to technical complications and hepatic insufficiency. Postoperative morbidity was 57.9%. Median survival time was 32 months (range 3 to 125 months). The 1-, 2-, and 5-year cumulative survival rates were 78.9%, 68%, and 49.1%, respectively. Tumor recurrence appeared in 13 patients and was the main cause of death (55.5%). Among the seven patients suffering from hepatocellular carcinoma, three are still alive at 31, 60, and 125 months after resection. In this group, 1-, 2-, and 5-year survival rates were 71.4%, 57.1%, and 38.1%. Among the 11 patients resected for colorectal liver metastases, the 1-, 2-, and 5-year survival rates were 81.8%, 62.3%, and 51.9%, respectively.
  
  
  CONCLUSIONS
  Liver resection combined with IVC resection and reconstruction is a feasible procedure that can be performed with an acceptable operative risk leading to longterm outcome in selected patients.
authors.affiliation: General Surgery Unit, Department of Surgery, Intensive Care Unit and Transplantations, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Nardo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Roberto
authors.initials: R
authors.lastname: Montalti
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bertelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Gardini
authors.forename: Paolo
authors.initials: P
authors.lastname: Beltempo
authors.forename: Lorenza
authors.initials: L
authors.lastname: Puviani
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pacilè
authors.forename: Marco
authors.initials: M
authors.lastname: Vivarelli
authors.forename: Antonino
authors.initials: A
authors.lastname: Cavallari
mesh_terms: D000328:Adult; D000368:Aged; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000556:secondary / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000401:mortality