title: Is radical surgery feasible in liver hydatid cysts in contact with the inferior vena cava?
abstract: BACKGROUND
  Cysts in contact with the inferior vena cava (IVC) represent a challenge for hepato-pancreatico-biliary surgeons. Although the literature on the topic is scarce, the most widely accepted approach is conservative surgery. Partial cyst resection is recommended, because radical resection is considered a high-risk procedure.
  
  
  METHODS
  This was a retrospective study over the period January 2007-December 2012. We operated on 103 patients with liver hydatidosis. A total of 32 patients (31 %) had a liver cyst in contact with the IVC. We proposed a cyst classification based on location of the cyst and length of contact and degrees of involvement of the IVC.
  
  
  RESULTS
  Median size of the contacting cyst measured by computed tomography (CT) was 12 cm. On CT, median length of contact with the IVC was 37 mm. The median degree of involvement was 90°. Radical surgery was performed in 20 patients (62.5 %). No IVC resection was done. Morbidity rate was 28 %, and mortality was 3 %. In follow-up (median 27 months), no relapses or problems related to IVC flow were detected. Postoperative stay and transfusion rate were higher in the conservative surgery group, but these patients presented fewer complications. There was no relationship between circumferential grades and length of contact with the IVC and the type of surgery performed.
  
  
  CONCLUSIONS
  Liver hydatid cysts in contact with the IVC are large cysts usually located in the right liver. They do not normally cause clinical symptoms related to IVC contact. Radical surgery is feasible, and was performed in 60 % of our series, but it is technically demanding. We propose a classification of cysts in contact with the IVC.
authors.affiliation: Hepato-Bilio-Pancreatic Surgical Unit, Department of Surgery, Guadalajara University Hospital, C/General Moscardó 26, 5-1, 28020, Guadalajara, Madrid, Spain, jose_ramia@hotmail.com.
authors.forename: J M
authors.initials: JM
authors.lastname: Ramia
authors.forename: A
authors.initials: A
authors.lastname: Serrablo
authors.forename: R
authors.initials: R
authors.lastname: De la Plaza
authors.forename: J
authors.initials: J
authors.lastname: Esarte
authors.forename: L
authors.initials: L
authors.lastname: Gijón
authors.forename: L
authors.initials: L
authors.lastname: Sarria
authors.forename: J
authors.initials: J
authors.lastname: Figueras
authors.forename: J
authors.initials: J
authors.lastname: García-Parreño
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004444:Echinococcosis, Hepatic / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult