title: Complex liver resection for hepatic tumours involving the inferior vena cava.
abstract: BACKGROUND
  Resection of liver tumours with involvement of inferior vena cava (IVC) is considered to have a high surgical risk.
  
  
  OBJECTIVE
  We retrospectively reviewed 23 patients who underwent hepatectomy with IVC resection in two West-European liver surgery Units.
  
  
  METHODS
  The tumours included liver metastases (n = 13), hepatocellular carcinoma (n = 4), intrahepatic cholangiocarcinoma (n = 3), liver haemangioma (n = 1), primary hepatic lymphoma (n = 1) and recurrent right adrenal gland carcinoma (n = 1).
  
  
  RESULTS
  IVC resection was associated with right hepatectomy in 8 cases, extended right hepatectomy in 9 cases, extended left hepatectomy in 3 cases, minor liver resection in 2 cases, and right hepatectomy with nephrectomy in one case. In 16 patients the IVC wall involvement was <30% of its circumference, and a tangential vena cava resection was performed. In 7 patients (30%) with >50% involvement, a caval segment was resected and replaced with a 20 mm ringed polytetrafluoroethylene graft. R0-resection was achieved in all patients. Median intraoperative blood loss was 1.100 ml (range 490-15,000). Fourteen patients were transfused with a median of 3 PRC units per patient (range 1-25). Major complications occurred in 9 patients. Postoperative stay in ICU was 2.3 ± 3.4 days (range 1-14) and hospital stay was 17.3 ± 2.6 days (range 5-62). In 14 patients, final pathology demonstrated microscopic IVC infiltration.
  
  
  CONCLUSIONS
  In selected patients with malignant involvement of the liver and IVC, surgical resection en bloc with IVC is the only possibility to achieve R0 resection, with acceptable mortality and morbidity, in units specialized in liver surgery.
authors.affiliation: Hepato-Biliary Surgery Unit, Department of Surgical Sciences, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Nuzzo
authors.forename: M
authors.initials: M
authors.lastname: Giordano
authors.forename: F
authors.initials: F
authors.lastname: Giuliante
authors.forename: S
authors.initials: S
authors.lastname: Lopez-Ben
authors.forename: M
authors.initials: M
authors.lastname: Albiol
authors.forename: J
authors.initials: J
authors.lastname: Figueras
mesh_terms: D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D009361:Neoplasm Invasiveness; D019043:Vascular Neoplasms / Q000473:pathology* / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000379:methods*; D014682:Vena Cava, Inferior