Resection of malignant tumors invading the vena cava: perioperative complications and long-term follow-up.
OBJECTIVE
Invasion of the vena cava by malignant tumors is generally considered an absolute contraindication for surgery as a result of high surgical risk. Surgical treatment with resection of the vena cava may be beneficial for selected patients. This study was performed to evaluate our experiences with resection of the vena cava for malignant tumors, with a special focus on secondary tumors involving the inferior caval vein.


METHODS
A total of 35 patients underwent extended resection of malignant tumors invading the vena cava. Prosthetic repair was performed in 13 patients by using a ringed polytetrafluoroethylene graft. Preoperative risk factors, mortality and morbidity, and long-term follow-up and graft patency rates were examined.


RESULTS
The operative mortality rate was 6%. Minor complications occurred in 12 patients (34%). The graft patency rate was 85%, and there was no graft-related perioperative morbidity. The 1-, 3-, and 5-year survival rates were 76%, 32%, and 21%, respectively, with a median survival of 29 months. Incomplete resection and cardiopulmonary risk have a significant negative effect on survival.


CONCLUSIONS
Radical resection of the vena cava is a feasible procedure in highly selected patients, with low morbidity and mortality and acceptable survival rates, especially in patients with complete resection of the tumor.
Kuehnl
Andreas
A
Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany. andreas.kuehnl@med.uni-muenchen.de
Schmidt
Michael
M
Hornung
Hans-Martin
HM
Graser
Anno
A
Jauch
Karl-Walter
KW
Kopp
Reinhard
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D001661:Biliary Tract Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011013:Pneumonectomy / Q000009:adverse effects* / Q000401:mortality; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D014682:Vena Cava, Inferior / Q000473:pathology*