title: Outcomes of Bypass Support Use during Inferior Vena Cava Resection and Reconstruction.
abstract: BACKGROUND
  The safety and effectiveness of using venovenous and cardiopulmonary bypass for resection of the inferior vena cava (IVC) is not well studied. The goal of this study was to compare outcomes following IVC resection with and without bypass support.
  
  
  METHODS
  We analyzed all patients undergoing IVC resection at our institution (September 1999 to June 2014) and compared the use of bypass support with cross-clamp alone using univariable and Kaplan-Meier analyses. The outcomes included perioperative complications and survival.
  
  
  RESULTS
  Sixty-three patients underwent IVC resection (mean age 58 ± 2 years, mean follow-up 21 ± 3 months). Bypass patients (32%) were similar to non-bypass patients (68%) in age, gender, tumor size, type, and grade (P = nonsignificant [NS]). Bypass patients were more likely to undergo complete IVC reconstruction (55% vs. 24%, P = 0.01) at the suprarenal level (62% vs. 35%, P = 0.05), and had higher intraoperative blood loss (9.6 ± 2.1 vs. 3.2 ± 1.4 L, P = 0.01). Complete R0 resection was similar between groups (50% vs. 52%, P = NS). There were more overall perioperative complications in bypass patients (P = 0.0005), with a trend toward more frequent venous thromboembolic events (40% vs. 21%, P = 0.13). The incidence of acute kidney injury (10% vs. 9%) and renal failure requiring dialysis (10% vs. 2%) was similar (P = NS). Length of stay was longer following bypass (12.2 ± 1.2 vs. 8.0 ± 0.1 days, P = 0.004). There were no differences in overall mortality (15% vs. 14%, P = NS) or tumor recurrence (50% vs. 47%, P = NS). Bypass patients had a nonsignificant trend toward longer disease-free survival (20.7 ± 5.2 vs. 10.4 ± 3.8 months, P = 0.12).
  
  
  CONCLUSIONS
  The use of bypass support for IVC resection is associated with more complex operations and higher rates of perioperative complications. However, the overall mortality and morbidity of bypass, including renal complications, is similar to cross-clamping alone. Thus, the need for bypass should not preclude attempts at complete tumor resection.
authors.affiliation: Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado Denver, Aurora, CO; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Natalia O
authors.initials: NO
authors.lastname: Glebova
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Caitlin W
authors.initials: CW
authors.lastname: Hicks
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Piazza
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Ying Wei
authors.initials: YW
authors.lastname: Lum
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Abularrage
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD. Electronic address: jhblack@jhmi.edu.
authors.forename: James H
authors.initials: JH
authors.lastname: Black
mesh_terms: D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D014682:Vena Cava, Inferior