Combined liver and inferior vena cava resection for adrenocortical carcinoma.
OBJECTIVE
Adrenocortical carcinoma (ACC) is a rare malignancy, usually diagnosed at an advanced stage when it has invaded or adhered to adjacent organs. We report our experience of performing combined liver and inferior vena cava (IVC) resection for ACC.


METHODS
Six patients with clinical stage III (n = 4) or IV (n = 2) ACC underwent combined resection of the liver and IVC. Two patients underwent extended right hepatectomy, and four underwent segmentectomy. In four patients, the IVC was resected segmentally: it was replaced with expanded polytetrafluoroethylene (ePTFE) in three of these patients, and not reconstructed in one. In two patients, the IVC was partially resected and closed directly.


RESULTS
Perioperative mortality was zero, and morbidity was 33.3%, with temporary liver failure in two patients and renal failure in one patient. Recurrence was found within 8.1 months in three (50%) of the six patients. The mean recurrence-free survival period was 20.1 +/- 7.7 months (95% confidence interval [CI]: 5.1-35.4), and the median survival time was 6.1 +/- 9.8 months (95% CI: 00-25.3). The 5-year disease-free survival rate was 16.7%.


CONCLUSIONS
Patients with ACC involving both the liver and IVC are candidates for partial hepatectomy and segmental IVC resection. Resection affords the possibility of negative margins, acceptable perioperative morbidity and mortality, and prolonged survival in some patients.
Ohwada
Susumu
S
Department of Surgery, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
Izumi
Masaru
M
Tanahashi
Yoshifumi
Y
Kawate
Susumu
S
Hamada
Kunihiro
K
Tsutsumi
Hirofumi
H
Horiguchi
Jun
J
Koibuchi
Yukio
Y
Takahashi
Toru
T
Yamada
Masanobu
M
D000306:Adrenal Cortex Neoplasms / Q000473:pathology* / Q000601:surgery*; D018268:Adrenocortical Carcinoma / Q000556:secondary* / Q000601:surgery*; D000328:Adult; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011138:Polytetrafluoroethylene; D015996:Survival Rate; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*
D011138:Polytetrafluoroethylene