Hepatic resection for primary or secondary malignancies with involvement of the inferior vena cava: is this operation safe or hazardous?
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.
Nardo
Bruno
B
General Surgery Unit, Department of Surgery, Intensive Care Unit and Transplantations, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Ercolani
Giorgio
G
Montalti
Roberto
R
Bertelli
Riccardo
R
Gardini
Andrea
A
Beltempo
Paolo
P
Puviani
Lorenza
L
Pacilè
Vincenzo
V
Vivarelli
Marco
M
Cavallari
Antonino
A
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