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1
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Lazar D, Stefan D, Marko D, Zlatanovic P, Sladojevic M, Ilijas C, Grubor N, Andreja D. Case series of the inferior vena cava primary leiomyosarcoma treatment. J Surg Case Rep 2024; 2024:rjad546. [PMID: 38840898 PMCID: PMC11151786 DOI: 10.1093/jscr/rjad546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/04/2023] [Indexed: 06/07/2024] Open
Abstract
Tumors of the inferior vena cava (IVC) are rare and usually malignant and they can be primary and secondary. The most common primary tumor of the IVC is primary leiomyosarcoma. The first case of primary IVC leiomyosarcoma has been described in 1871 [1].The total number of 218 cases has collected until 1996 [2]. After that, three large single center series of these tumors emerged [3-5]. Present a series of five cases of these tumors. All the patients underwent a wide complete resection of tumors and the reconstruction with Dacron grafts. One patient died 19 months after the surgery, while the remaining ones survived without a local and system disease relapse. Although a surgical resection combined with the chemotherapy is often not curative, it can achieve a significant long-term survival. For this reason, we recommend the aggressive surgical management using the modern vascular surgical and oncology techniques.
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Affiliation(s)
- Davidovic Lazar
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Koste Todorovića Street 8, Belgrade 11000, Serbia
| | - Ducic Stefan
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragas Marko
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Koste Todorovića Street 8, Belgrade 11000, Serbia
| | | | - Milos Sladojevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Koste Todorovića Street 8, Belgrade 11000, Serbia
| | - Cinara Ilijas
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikica Grubor
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Dimic Andreja
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Koste Todorovića Street 8, Belgrade 11000, Serbia
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2
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Radulova-Mauersberger O, Weitz J, Riediger C. Vascular surgery in liver resection. Langenbecks Arch Surg 2021; 406:2217-2248. [PMID: 34519878 PMCID: PMC8578135 DOI: 10.1007/s00423-021-02310-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/18/2021] [Indexed: 01/04/2023]
Abstract
Vascular surgery in liver resection is a standard part of liver transplantation, but is also used in oncological liver surgery. Malignant liver tumors with vascular involvement have a poor prognosis without resection. Surgery is currently the only treatment to provide long-term survival in advanced hepatic malignancy. Even though extended liver resections are increasingly performed, vascular involvement with need of vascular reconstruction is still considered a contraindication for surgery in many institutions. However, vascular resection and reconstruction in liver surgery-despite being complex procedures-are safely performed in specialized centers. The improvements of the postoperative results with reduced postoperative morbidity and mortality are a result of rising surgical and anesthesiological experience and advancements in multimodal treatment concepts with preconditioning measures regarding liver function and systemic treatment options. This review focuses on vascular surgery in oncological liver resections. Even though many surgical techniques were developed and are also used during liver transplantation, this special procedure is not particularly covered within this review article. We provide a summary of vascular reconstruction techniques in oncological liver surgery according to the literature and present also our own experience. We aim to outline the current advances and standards in extended surgical procedures for liver tumors with vascular involvement established in specialized centers, since curative resection improves long-term survival and shifts palliative concepts to curative therapy.
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Affiliation(s)
- Olga Radulova-Mauersberger
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.
- German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany.
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Carina Riediger
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
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3
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Debing E, Niepen PVD, Goossens A, Brande PVD. Intracaval Extension of a Recurrent Low-Grade Endometrial Stromal Sarcoma. Acta Chir Belg 2020. [DOI: 10.1080/00015458.1998.12098429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- E. Debing
- Departments of Vascular Surgery, Academic Hospital, Vrije Universiteit Brussel, Brussels, Belgium
| | - P. Van Der Niepen
- Departments of Nephrology, Academic Hospital, Vrije Universiteit Brussel, Brussels, Belgium
| | - A. Goossens
- Departments of Pathology, Academic Hospital, Vrije Universiteit Brussel, Brussels, Belgium
| | - P. Van den Brande
- Departments of Vascular Surgery, Academic Hospital, Vrije Universiteit Brussel, Brussels, Belgium
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4
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Baimas-George M, Tschuor C, Watson M, Sulzer J, Salibi P, Iannitti D, Martinie JB, Baker E, Clavien PA, Vrochides D. Current trends in vena cava reconstructive techniques with major liver resection: a systematic review. Langenbecks Arch Surg 2020; 406:25-38. [PMID: 32979105 DOI: 10.1007/s00423-020-01989-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/07/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE Historically, invasion of the inferior vena cava (IVC) represented advanced and often unresectable hepatic disease. With surgical and anesthetic innovations, IVC resection and reconstruction have become feasible in selected patients. This review assesses technical variations in reconstructive techniques and post-operative management. METHODS A comprehensive literature search was performed according to PRISMA. Inclusion criteria were (i) peer-reviewed articles in English; (ii) at least three cases; (iii) hepatic IVC resection and reconstruction (January 2015-March 2020). Primary outcomes were reconstructive technique, anti-thrombotic regimen, post-operative IVC patency, and infection. Secondary outcomes included post-operative complications and malignant disease survival. RESULTS Fourteen articles were included allowing for investigation of 351 individual patients. Analysis demonstrated significant heterogeneity in surgical reconstructive technique, anti-thrombotic management, and post-operative monitoring of patency. There was increased utilization of ex vivo approaches and decreased use of venovenous bypass compared with previously published reviews. CONCLUSION This review of literature published between 2015 and 2020 reveals persistent heterogeneity of hepatic IVC reconstructive techniques and peri-operative management. Increased utilization of ex vivo approaches and decreased use of venovenous bypass point towards improved operative techniques, peri-operative management, and anesthesia. In order to gain evidence for consensus on management, a registry would be beneficial.
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Affiliation(s)
- Maria Baimas-George
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA
| | - Christoph Tschuor
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA.,Department of Surgery & Transplantation, University Hospital of Zurich, Zurich, Switzerland
| | - Michael Watson
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA
| | - Jesse Sulzer
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA
| | - Patrick Salibi
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA
| | - David Iannitti
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA
| | - John B Martinie
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA
| | - Erin Baker
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA
| | - Pierre-Alain Clavien
- Department of Surgery & Transplantation, University Hospital of Zurich, Zurich, Switzerland
| | - Dionisios Vrochides
- Division of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive; Suite 600, Charlotte, NC, 28204, USA.
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5
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Djaladat H, Ghoreifi A, Basin MF, Hugen C, Aslzare M, Miranda G, Hwang DH, Schuckman AK, Aron M, Thangathurai D, Duddalwar V, Daneshmand S. Perioperative Outcome of Suprarenal Resection of Vena Cava Without Reconstruction in Urologic Malignancies: A Case Series and Review of the Literature. Urology 2020; 142:146-154. [PMID: 32339562 DOI: 10.1016/j.urology.2020.02.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe the feasibility and perioperative outcome of suprarenal resection of inferior vena cava (IVC) in urologic neoplasms without reconstruction. METHODS We retrospectively reviewed the patients who underwent suprarenal resection of IVC without reconstruction for urologic neoplasms in our institution between September 2010 and October 2019. Patients' demographic, clinical, radiologic, and 90-day perioperative complications were recorded. RESULTS Twenty-eight (79% male) patients with a median age of 59 (25-75) years were included in the study. Twenty-five (89%) of patients had renal cell carcinoma, 1 had renal leiomyosarcoma, and 2 had metastatic testicular teratoma. Twenty-two patients had Mayo level 3 thrombus, 3 had level 2, and 3 had level 4. The mean radiologic thrombus length was 12.6 cm. Eleven patients had radiologic bland thrombosis in the infrarenal IVC. Twenty-seven patients underwent open, and 1 robotic surgery. The median operating time was 411 (range 240-808) minutes, median blood loss was 3750 cc, and all but 1 patient received perioperative transfusion (median 11 units of packed red blood cells). Median hospital stay was 5 (3-50) days. Ninety-day complication rate was 35% (Clavien-Dindo grade I/II and III/IV were 21% and 14%, respectively). Four patients (14%) developed transient nondisabling leg edema. The 90-day mortality rate was 7%. CONCLUSION Suprarenal inferior vena cava resection without reconstruction is feasible, yet high-risk operation that should be performed in experienced centers in selected patients with urologic malignancies.
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Affiliation(s)
- Hooman Djaladat
- Institute of Urology, University of Southern California, Los Angeles, CA.
| | - Alireza Ghoreifi
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Michael F Basin
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Cory Hugen
- Institute of Urology, University of California Irvine, Irvine, CA
| | - Mohammad Aslzare
- Institute of Urology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gus Miranda
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Darryl H Hwang
- Department of Radiology, University of Southern California, Los Angeles, CA
| | - Anne K Schuckman
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Manju Aron
- Department of Pathology, University of Southern California, Los Angeles, CA
| | | | - Vinay Duddalwar
- Department of Radiology, University of Southern California, Los Angeles, CA
| | - Siamak Daneshmand
- Institute of Urology, University of Southern California, Los Angeles, CA
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6
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Laddha A, Bijalwan P, Thomas A, Kumar P G. Small Renal Mass with Level 4 IVC Thrombus. Indian J Surg Oncol 2019; 10:196-198. [PMID: 30948898 DOI: 10.1007/s13193-018-0835-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/20/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Abhishek Laddha
- Department of Urology, Amrita Institute of Medical Sciences and Research Center, AIMS Ponekkara P.0, Kochi, Kerala 682041 India
| | - Priyank Bijalwan
- Department of Urology, Amrita Institute of Medical Sciences and Research Center, AIMS Ponekkara P.0, Kochi, Kerala 682041 India
| | - Appu Thomas
- Department of Urology, Amrita Institute of Medical Sciences and Research Center, AIMS Ponekkara P.0, Kochi, Kerala 682041 India
| | - Ginil Kumar P
- Department of Urology, Amrita Institute of Medical Sciences and Research Center, AIMS Ponekkara P.0, Kochi, Kerala 682041 India
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7
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Tomimaru Y, Eguchi H, Wada H, Doki Y, Mori M, Nagano H. Liver resection combined with inferior vena cava resection and reconstruction using artificial vascular graft: A literature review. Ann Gastroenterol Surg 2018; 2:182-186. [PMID: 29863183 PMCID: PMC5980586 DOI: 10.1002/ags3.12068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/09/2018] [Indexed: 11/10/2022] Open
Abstract
In cases where liver tumors invade the inferior vena cava (IVC), IVC resection along with liver resection may be needed to effect a cure. Furthermore, if the IVC defect is large, IVC reconstruction with vascular graft after resection is required. There are limited reports of cases of IVC reconstruction using a graft. By reviewing data from the literature of previous studies, the present study was aimed at investigating the surgical outcomes of liver resection with IVC resection and reconstruction using an artificial vascular graft. PubMed was searched for previous articles reporting cases with the combined surgery. The search was limited to articles in English, and cases with exceptional surgeries such as in situ cold perfusion, and ante situm and ex vivo techniques were excluded from this study. Surgical outcomes of the extracted cases were investigated. Cases dealt only with primary closure after IVC resection, and those in which the IVC tumor thrombus was treated by opening the IVC wall, removing the thrombus and then closing the IVC without wall excision were not included in this study. The literature search identified 13 studies, including 111 cases. Operative mortality in the reported cases was 8.1% (9 out of 111 cases). Thrombus in the artificial vascular graft was observed in two cases, and patency of the graft during the follow-up period was confirmed in 109 of the 111 cases (98.2%). These results suggested that the surgical outcomes of liver resection combined with IVC resection and reconstruction using the artificial vascular graft were favorable.
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Affiliation(s)
- Yoshito Tomimaru
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuitaJapan
- Department of Gastroenterological SurgeryToyonaka Municipal HospitalToyonakaJapan
| | - Hidetoshi Eguchi
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Hiroshi Wada
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuitaJapan
- Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Yuichiro Doki
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Masaki Mori
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Hiroaki Nagano
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuitaJapan
- Department of Gastroenterological, Breast and Endocrine SurgeryYamaguchi University Graduate School of MedicineUbeJapan
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8
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Zhou Y, Wu L, Xu D, Wan T, Si X. A pooled analysis of combined liver and inferior vena cava resection for hepatic malignancy. HPB (Oxford) 2017. [PMID: 28645571 DOI: 10.1016/j.hpb.2017.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Limited data are currently available to address the safety and efficacy of combined resection of the liver and inferior vena cava (IVC) for hepatic malignancies. METHODS A systematic review was performed to identify relevant studies. Pooled individual data were examined for the clinical outcome of combined resection of the liver and IVC for hepatic malignancies. RESULTS A total of 258 patients were described in 38 articles eligible for inclusion. Resections were performed for colorectal liver metastasis (CLM) [n = 128 (50%)], intrahepatic cholangiocarcinoma (ICC) [n = 51 (20%)], hepatocellular carcinoma (HCC) [n = 48 (19%)], and other pathologies [n = 31 (11%)]. There were 14 (5%) perioperative deaths. The median survival duration was 34 months, and the 1-, 3- and 5-year overall survival (OS) rate was 79%, 46% and 33%, respectively. The 5-year OS rate was 26% for CLM, 37% for ICC, and 30% for HCC. CONCLUSION Combined resection of the liver and IVC for hepatic malignancies is safe and applicable, and offers acceptable survival outcomes.
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Affiliation(s)
- Yanming Zhou
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China.
| | - Lupeng Wu
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Dong Xu
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Tao Wan
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xiaoying Si
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
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9
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Suryawanshi PR, Agrawal MM. Laparoscopic excision of leiomyosarcoma of inferior vena cava. J Minim Access Surg 2017; 13:303-305. [PMID: 28782739 PMCID: PMC5607799 DOI: 10.4103/jmas.jmas_152_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Leiomyosarcoma of inferior vena cava (IVC) is a rare soft tissue tumour. Only 0.5% of all soft tissue sarcomas of adults and only 300 cases are reported till date. We describe our encounter with such a case where we were successful in radical excision of tumour with the use of vascular staplers on the IVC without compromising IVC lumen. Leiomyosarcoma of IVC is a rare entity, and laparoscopic excision of the tumour is possible in exophytic tumour.
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Affiliation(s)
| | - Mohit Munesh Agrawal
- Department of General Surgery, MGM Medical College and Hospital, Aurangabad, Maharashtra, India
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10
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Cawich SO, Thomas DAW, Ragoonanan V, Ramjit C, Narinesingh D, Naraynsingh V, Pearce N. Modified hanging manoeuvre facilitates inferior vena cava resection and reconstruction during extended right hepatectomy: A technical case report. Mol Clin Oncol 2017; 7:687-692. [PMID: 28856002 DOI: 10.3892/mco.2017.1352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 07/22/2017] [Indexed: 12/16/2022] Open
Abstract
Liver resections are safe when performed by specialized hepatobiliary teams. However, complex liver resections are accompanied by significant perioperative risk and they may require modifications of the conventional surgical techniques. We herein report the case of a 54-year-old male patient who underwent an extended right liver resection with en bloc resection and reconstruction of the inferior vena cava. For this complex resection, a modification of the standard operative technique was required. A modified hanging manoeuvre was performed using two 19Fr nasogastric tubes outside the traditional avascular plane to facilitate resection. This modification of the hanging manoeuvre was proven to be feasible and safe, and it is recommended for inclusion in the armamentarium of hepatobiliary surgeons when complex resections are required.
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Affiliation(s)
- Shamir O Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, The Republic of Trinidad and Tobago
| | - Dexter A W Thomas
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, The Republic of Trinidad and Tobago
| | - Vindra Ragoonanan
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, The Republic of Trinidad and Tobago
| | - Chunilal Ramjit
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, The Republic of Trinidad and Tobago
| | - Dylan Narinesingh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, The Republic of Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, The Republic of Trinidad and Tobago
| | - Neil Pearce
- Hepatobiliary Division, Department of Surgery, Southampton General Hospital, SO16 6YD Southampton, UK
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11
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Le Roy B, Buc E, Hordonneau C, Veziant J, Pezet D, Gagnière J. An original technique of venous autoplasty after duodenopancreatectomy for tumors involving the infrarenal inferior vena cava. J Surg Case Rep 2017; 2017:rjx011. [PMID: 28458822 PMCID: PMC5400417 DOI: 10.1093/jscr/rjx011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/13/2016] [Accepted: 01/24/2017] [Indexed: 11/19/2022] Open
Abstract
Tumor involvement of the inferior vena cava (IVC) by hepatobiliary, pancreatic or duodenal malignancies can compromise adequate resection. However, radical resection with negative histological margins remains the only chance of cure. Various techniques are used for venous reconstruction, using a prosthetic graft interposition in most of the cases. However, in case of associated digestive resections, such as pancreaticoduodenectomy, postoperative complications can be responsible for prosthesis infection and related vascular complications. In this setting, the use of biological material for venous reconstruction appears to be preferable. We present an original, easy and useful technique of a venous autoplasty after pancreaticoduodenectomy for tumors involving the anterior wall of the infrarenal IVC, using a patch from the posterior wall of the IVC.
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Affiliation(s)
- Bertrand Le Roy
- 1Department of Digestive and Hepatobiliary Surgery, Liver Transplantation, Estaing University Hospital, Clermont-Ferrand 63000, France
| | - Emmanuel Buc
- 1Department of Digestive and Hepatobiliary Surgery, Liver Transplantation, Estaing University Hospital, Clermont-Ferrand 63000, France.,UMR 1071 Inserm, University of Auvergne, Clermont-Ferrand 63000, France
| | - Constance Hordonneau
- Department of Radiology, Estaing University Hospital, Clermont-Ferrand 63000, France
| | - Julie Veziant
- 1Department of Digestive and Hepatobiliary Surgery, Liver Transplantation, Estaing University Hospital, Clermont-Ferrand 63000, France
| | - Denis Pezet
- 1Department of Digestive and Hepatobiliary Surgery, Liver Transplantation, Estaing University Hospital, Clermont-Ferrand 63000, France.,UMR 1071 Inserm, University of Auvergne, Clermont-Ferrand 63000, France
| | - Johan Gagnière
- 1Department of Digestive and Hepatobiliary Surgery, Liver Transplantation, Estaing University Hospital, Clermont-Ferrand 63000, France.,UMR 1071 Inserm, University of Auvergne, Clermont-Ferrand 63000, France
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12
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Illuminati G, Pizzardi G, Calio' F, Pacilè MA, Masci F, Vietri F. Outcome of inferior vena cava and noncaval venous leiomyosarcomas. Surgery 2016; 159:613-20. [DOI: 10.1016/j.surg.2015.08.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/26/2015] [Accepted: 08/26/2015] [Indexed: 01/22/2023]
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13
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Loh A, Bishop M, Krasin M, Davidoff AM, Langham MR. Long-term physiologic and oncologic outcomes of inferior vena cava thrombosis in pediatric malignant abdominal tumors. J Pediatr Surg 2015; 50:550-5. [PMID: 25840061 DOI: 10.1016/j.jpedsurg.2014.11.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 11/24/2014] [Accepted: 11/24/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The long-term physiologic and oncologic outcomes of treatment for inferior vena cava (IVC) thrombosis in children with malignant abdominal tumors are unclear. METHODS We conducted a retrospective review of children with malignant IVC tumor thrombosis treated at our institution between January 1996 and December 2011. Extent of tumor thrombus was classified using the Hinman system. Disease stage, management, and oncologic and physiologic outcomes and complications were evaluated. RESULTS We identified 15 patients (median age, 4.7 years): 12 with Wilms tumor, 2 with hepatoblastoma, and 1 with adrenocortical carcinoma. Neoadjuvant chemotherapy changed Hinman levels in 2 (13%) patients. IVC thrombus resection was complete in 6 (40%) patients, partial in 7 (47%) patients, and not performed in 1 (6.7%) patient. On follow-up imaging, 8 (53%) patients' IVCs were patent, 6 (40%) had residual thrombus, and 1 (6.7%) was surgically interrupted. Three (20%) patients had perioperative complications, and 2 (13%) experienced transient effects related to IVC occlusion. CONCLUSIONS Surgical management of tumor thrombus in the vena cava of children with solid abdominal tumors is challenging. Evidence on which to base strong treatment recommendations is lacking. Few long-term physiologic complications were observed.
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Affiliation(s)
- Amos Loh
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, United States; Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Michael Bishop
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, United States
| | - Matthew Krasin
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, United States
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, United States; Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN 38103, United States
| | - Max R Langham
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, United States; Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN 38103, United States; Division of Pediatric Surgery, Le Bonheur Children's Hospital, Memphis, TN 38103, United States.
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Complex liver resections for colorectal metastases: are they safe in the low-volume, resource-poor Caribbean setting? Case Rep Surg 2015; 2015:570968. [PMID: 25713743 PMCID: PMC4332977 DOI: 10.1155/2015/570968] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 01/21/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction. Although many authorities suggest that major liver resections should only be carried out in high-volume specialized centres, many patients in the Caribbean do not have access to these health care systems. Presentation of a Case. A 50-year-old woman with a solitary colorectal metastasis invading the inferior vena cava underwent an extended left hepatectomy with caval resection and reconstruction. Several technical maneuvers were utilized that were suited to the resource-poor environment. Conclusion. We suggest that good outcomes can still be attained in the resource-poor, low-volume centres once dedicated and appropriately trained teams are available.
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End-to-End Renal Vein Anastomosis to Preserve Renal Venous Drainage Following Inferior Vena Cava Radical Resection due to Leiomyosarcoma. Ann Vasc Surg 2014; 28:1048-51. [DOI: 10.1016/j.avsg.2013.08.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 08/17/2013] [Accepted: 08/31/2013] [Indexed: 11/21/2022]
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Azoulay D, Pascal G, Salloum C, Adam R, Castaing D, Tranecol N. Vascular reconstruction combined with liver resection for malignant tumours. Br J Surg 2014; 100:1764-75. [PMID: 24227362 DOI: 10.1002/bjs.9295] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND The resectability criteria for malignant liver tumours have expanded during the past two decades. The use of vascular reconstruction after hepatectomy has been integral in this process. However, the majority of reports are anecdotal. This is a retrospective analysis of the techniques, morbidity, mortality and risk factors of liver resections with vascular reconstruction based on a large series from a single centre. METHODS Patients who underwent hepatic resection combined with vascular resection and reconstruction between 1997 and 2009 were included in this study. Indications for surgery, morbidity and 90-day mortality are reported along with factors predictive of operative mortality. RESULTS Eighty-four patients had liver resection with 97 vascular resections and reconstruction. There were 44 men and 40 women with a mean(s.d.) age of 56·9(12·1) years. Mean(s.d.) follow-up was 37·3(34·1) months. All patients had primary or metastatic liver tumours. The perioperative morbidity rate was 62 per cent (52 patients) and the operative mortality rate 14 per cent (12). Predictors of operative mortality were: bilirubin level exceeding 34 µmol/ml (P = 0·023), indocyanine green retention rate at 15 min over 10 per cent (P = 0·031), duration of ischaemia (P = 0·011), amount of blood transfused (P = 0·025) and combined major extrahepatic procedure (P = 0·042). Actuarial 3- and 5-year survival rates were 44 and 26 per cent respectively. CONCLUSION Liver resection with combined vascular resection and reconstruction can be performed in selected patients with acceptable morbidity and mortality. The lack of therapeutic alternatives and the poor outcome of non-operative management seem to justify this approach. The identification of risk factors should help improve patient selection and postoperative outcome as well as facilitate objective risk communication with surgical candidates.
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Affiliation(s)
- D Azoulay
- Centre Hépato-Biliaire, Département de Chirurgie Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Paul Brousse, Villejuif; Service de Chirurgie Hépato-Bilio-Pancreatique, AP-HP Hôpital Henri Mondor, Créteil, France
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González J, Gorin MA, Garcia-Roig M, Ciancio G. Inferior vena cava resection and reconstruction: Technical considerations in the surgical management of renal cell carcinoma with tumor thrombus. Urol Oncol 2014; 32:34.e19-26. [DOI: 10.1016/j.urolonc.2013.01.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 01/14/2013] [Accepted: 01/14/2013] [Indexed: 10/27/2022]
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18
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Liu Y, Sun Y, Jiang Y, He XY, Kong QX, Wu JX, Zhang YS, Jin X. A Novel Strategy of Vascular Reconstruction After Radical Resection of an Inferior Vena Cava Leiomyosarcoma. Ann Vasc Surg 2013; 27:803.e1-5. [DOI: 10.1016/j.avsg.2012.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 10/14/2012] [Accepted: 10/17/2012] [Indexed: 11/26/2022]
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Biswas S, Amin A, Chaudry S, Joseph S. Leiomyosarcoma of the Inferior Vena Cava - Radical Resection, Vascular Reconstruction and Challenges: A Case Report and Review of Relevant Literature. World J Oncol 2013; 4:107-113. [PMID: 29147340 PMCID: PMC5649677 DOI: 10.4021/wjon471w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2012] [Indexed: 11/03/2022] Open
Abstract
Leiomyosarcomas of the inferior Vena Cava (IVC) are rare soft tissue sarcomas accounting for only 0.5% of all soft tissue sarcomas in adults with fewer than 300 cases reported. Extraluminal tumor growth along the adventitia of the IVC seems to be the common presentation. Intraluminal tumor growth is rare. The origin of the tumor is divided into three levels in relation to the hepatic and renal veins. The presentations and surgical modalities vary accordingly. Retroperitoneal tumors are often not diagnosed until the disease is at an advanced stage with large tumor growth and involvement of surrounding structures. This is partly because of the nonspecific clinical presentation as well as absence of early symptoms. Most patients present with abdominal or flank pain. Symptoms vary according to the dimensions of the tumor, growth pattern and localization of the tumor. Radical en bloc resection of the affected venous segment remains the only therapeutic option associated with prolonged survival. The goals of surgical management of these tumors include the achievement of local tumor control, maintenance of caval flow, and the prevention of recurrence. The involvement of renal or hepatic veins determines the strategy for vascular reconstruction. Reconstruction of the IVC is not always required, because gradual occlusion of the IVC allows the development of venous collaterals. However, when pararenal leiomyosarcoma of the IVC is present, reconstruction of the IVC and the renal vein is necessary to prevent transient or permanent renal dysfunction. Recent study has shown that radical surgery combined with adjuvant multimodal therapy has improved the cumulative survival rate. We report a case of IVC leiomyosarcoma in a young healthy woman along with details of its diagnostic workup and discussion of the surgical options and reconstruction of caval continuity.
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Affiliation(s)
- Saptarshi Biswas
- Department of General Surgery, Westchester University Medical Center, NY, USA
| | - Arpit Amin
- Department of General Surgery, Westchester University Medical Center, NY, USA
| | - Suhaib Chaudry
- Department of Surgical Oncology, St Vincents Medical Center, Bridgeport, CT, USA
| | - Saju Joseph
- Department of Surgical Oncology, St Vincents Medical Center, Bridgeport, CT, USA
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20
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Ali SM, Clark CJ, Zaydfudim VM, Que FG, Nagorney DM. Role of Major Vascular Resection in Patients with Intrahepatic Cholangiocarcinoma. Ann Surg Oncol 2012; 20:2023-8. [DOI: 10.1245/s10434-012-2808-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Indexed: 12/22/2022]
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Fukuda A, Ogura Y, Kanazawa H, Mori A, Kawaguchi M, Takada Y, Uemoto S. Living donor liver transplantation for Budd-Chiari syndrome with hepatic inferior vena cava obstruction after open pericardial procedures. Surg Today 2012. [PMID: 23188387 DOI: 10.1007/s00595-012-0440-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Living donor liver transplantation (LDLT) for Budd-Chiari syndrome (BCS) presents a unique challenge as it does not involve replacement of the hepatic inferior vena cava (IVC). We report a case of successful LDLT in a patient with BCS associated with occlusion of the hepatic veins as well as the IVC. A 34-year-old woman with a history of two open pericardial procedures had decompensated liver failure and portal hypertension. Venography showed complete obstruction of the hepatic IVC and well-developed collateral vessels. We performed LDLT via sternotomy and laparotomy, with an end-to-end anastomosis between the left hepatic vein of the donor and the patient's suprahepatic vena cava in the pericardium. The patient recovered uneventfully and has been doing well for 5 years. LDLT without caval replacement for BCS in a patient with hepatic IVC obstruction is feasible if the patient has good functional collaterals before liver transplantation.
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Affiliation(s)
- Akinari Fukuda
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University Hospital, Kyoto, Japan,
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Vladov NN, Mihaylov VI, Belev NV, Mutafchiiski VM, Takorov IR, Sergeev SK, Odisseeva EH. Resection and reconstruction of the inferior vena cava for neoplasms. World J Gastrointest Surg 2012; 4:96-101. [PMID: 22590663 PMCID: PMC3351494 DOI: 10.4240/wjgs.v4.i4.96] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 02/27/2012] [Accepted: 03/10/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the results of an aggressive surgical approach of resection and reconstruction of the inferior vena cava (IVC).
METHODS: The approach to caval resection depends on the extent and location of tumor involvement. The supra- and infra-hepatic portion of the IVC was dissected and taped. Left and right renal veins were also taped to control the bleeding. In 12 of the cases with partial tangential resection of the IVC, the flow was reduced to less than 40% so that the vein was primarily closed with a running suture. In 3 of the cases, the lumen of the vein was significantly reduced, requiring the use of a polytetrafluoroethylene (PTFE) patch. In 2 of the cases with segmental resection of the IVC, a PTFE prosthesis was used and in 1 case, the IVC was resected without reconstruction due to shunting the blood through the azygos and hemiazygos veins.
RESULTS: The mean operation time was 266 min (230-310 min) with an average intraoperative blood loss of 300 mL (200-2000 mL). The patients stayed in intensive care unit for 1.8 d (1-3 d). Mean hospital stay was 9 d (7-15 d). Twelve patients (66.7%) had no complications and 6 patients (33.3%) had the following complications: acute bleeding in 2 patients; bile leak in 2 patients; intra abdominal abscess in 1 patient; pulmonary embolism in 2 patients; and partial thrombosis of the patch in 1 patient. General complications such as pneumonia, pleural effusion and cardiac arrest were observed in the same group of patients. In all but 1 case, the complications were transient and successfully controlled. The mortality rate was 11.1% (n = 2). One patient died due to cardiac arrest and pulmonary embolism in the operation room and the second one died 2 d after surgery due to coagulopathy. With a median follow-up of 24 mo, 5 (27.8%) patients died of tumor recurrence and 11 (61.1%) are still alive, but three of them have a recurrence on computed tomography.
CONCLUSION: There are a variety of options for reconstruction after resection of the IVC that offers a higher resectable rate and better prognosis in selected cases.
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Affiliation(s)
- Nikola Nikolov Vladov
- Nikola Nikolov Vladov, Vassil Ivanov Mihaylov, Nikolai Vassilev Belev, Ventzislav Metodiev Mutafchiiski, Ivelin Rumenov Takorov, Sergei Kirilov Sergeev, Evelina Hristova Odisseeva, Hepato-biliary, Pancreatic and Transplant Surgery, Military Medical Academy, Sofia 1606, Bulgaria
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23
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Mann GN, Mann LV, Levine EA, Shen P. Primary leiomyosarcoma of the inferior vena cava: A 2-institution analysis of outcomes. Surgery 2012; 151:261-7. [DOI: 10.1016/j.surg.2010.10.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 10/18/2010] [Indexed: 11/24/2022]
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Anaya-Ayala JE, Cheema ZF, Davies MG, Lumsden AB, Reardon MJ. Concomitant Reconstruction of Infrarenal Aorta and Inferior Vena Cava After En Bloc Resection of Retroperitoneal Rhabdomyosarcoma. Vasc Endovascular Surg 2011; 45:769-72. [DOI: 10.1177/1538574411418128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Javier E. Anaya-Ayala
- Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital and The Methodist Hospital Research Institute, Houston, TX, USA
| | - Zulfiqar F. Cheema
- Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital and The Methodist Hospital Research Institute, Houston, TX, USA
| | - Mark G. Davies
- Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital and The Methodist Hospital Research Institute, Houston, TX, USA
| | - Alan B. Lumsden
- Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital and The Methodist Hospital Research Institute, Houston, TX, USA
| | - Michael J. Reardon
- Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital and The Methodist Hospital Research Institute, Houston, TX, USA
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Di Benedetto F, D'Amico G, Montalti R, Ballarin R, Tarantino G, Pecchi A, Gerunda GE. Banked depopulated vena caval homograft: a new strategy to restore caval continuity. Surg Innov 2011; 19:NP5-9. [PMID: 21719437 DOI: 10.1177/1553350611410075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study reports one case of primary inferior vena cava (IVC) leiomyosarcoma. A 67-year-old woman was referred to the authors' clinic for evaluation. She presented complaining of epigastric and right upper abdominal quadrant pain. Contrast-enhanced abdominal computed tomography scan revealed a 5.2 × 6.4 cm heterogeneously enhancing mass involving the anteromedial aspect of the IVC, below the renal vein (segment I), deforming the duodenum. There was a partial intraluminal extension in the IVC. Laparotomic resection was performed, with total en bloc excision of the lower IVC tumor. The caval continuity was restored with concomitant interposition of a banked depopulated vena cava homograft. Histological findings showed leiomyosarcoma originating from IVC. The postoperative course was uneventful: Neither recurrence nor metastasis was evident at 4 years postsurgery.
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Affiliation(s)
- Fabrizio Di Benedetto
- Liver and Multivisceral Transplant Center, Department of General Surgery, University of Modena and Reggio Emilia, Modena, Italy.
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26
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Angiletta D, Fullone M, Greco L, Marinazzo D, Frontino P, Regina G. Leiomyosarcoma of the Inferior Vena Cava: Resection and Vascular Reconstruction Using a Dacron Graft and an Adam De Weese Clip—Three-Year Follow-Up. Ann Vasc Surg 2011; 25:557.e5-9. [DOI: 10.1016/j.avsg.2010.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 12/29/2010] [Accepted: 12/30/2010] [Indexed: 11/25/2022]
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Seki M, Asano K, Ishigaki K, Iida G, Teshima K, Watari T, Tanaka S. En block resection of a large hepatocellular carcinoma involving the caudal vena cava in a dog. J Vet Med Sci 2010; 73:693-6. [PMID: 21187679 DOI: 10.1292/jvms.10-0199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 13-year-old neutered female Shih Tzu was referred for investigation of a cranial abdominal mass. Investigations including conventional radiography, abdominal ultrasonography and computed tomography confirmed the mass in the caudate lobe of the liver. As a collateral vein originating from the caudal vena cava (CVC) communicated with the azygos vein, the CVC was ligated and transected cranial to the right renal vein and cranial to the mass under temporary occlusion of the thoracic descending aorta and posthepatic CVC. The mass combined with the CVC was excised. The mass was confirmed as hepatocellular carcinoma (HCC). This report describes the first case with successful en bloc resection of a large HCC involving the CVC in a dog.
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Affiliation(s)
- Mamiko Seki
- Laboratory of Comprehensive Veterinary Clinical Studies, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Fujisawa, Kanagawa, Japan
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Alexander A, Rehders A, Raffel A, Poremba C, Knoefel WT, Eisenberger CF. Leiomyosarcoma of the inferior vena cava: radical surgery and vascular reconstruction. World J Surg Oncol 2009; 7:56. [PMID: 19558690 PMCID: PMC2710329 DOI: 10.1186/1477-7819-7-56] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 06/26/2009] [Indexed: 11/11/2022] Open
Abstract
Background Vascular leiomyosarcoma are rare tumors typically originating from the inferior vena cava (IVC). Due to nonspecific clinical signs most tumors are diagnosed at advanced stages. Complete surgical resection remains the only potential curative therapeutic option. Surgical strategy is particularly influenced by the level of the IVC affected. Due to the topographic relation to the renal veins level-II involvement of the IVC raises special surgical challenges with respect to the maintenance of venous outflow. Case presentation We herein report two cases of leiomyosarcoma of the IVC with successful en bloc resection and individualized caval reconstruction. One patient presented with a large intramural and intraluminal mass and received a complete circumferential resection. Reconstruction was performed by graft replacement of the caval segment affected. The other patient displayed a predominantly extraluminal tumor growth and underwent semicircumferential resection of the IVC including the confluence of the left renal vein. In this case vascular reconstruction was performed by cavoplasty and reinsertion of the left renal vein into the proximal portion of the IVC. Resection margins of both patients were tumor free and no clinical signs of venous insufficiency of the lower extremity occurred. Conclusion This paper presents two cases of successfully managed leiomyosarcomas of the vena cava and exemplifies two different options for vascular reconstruction in level II sarcomas and includes a thorough review of the literature.
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Affiliation(s)
- Andrea Alexander
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsklinikum Düsseldorf, Germany.
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29
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DuBay DA, Lindsay T, Swallow C, McGilvray I. A cylindrical femoral vein panel graft for caval reconstructions. J Vasc Surg 2009; 49:255-9. [PMID: 19174264 DOI: 10.1016/j.jvs.2008.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 08/01/2008] [Accepted: 08/01/2008] [Indexed: 11/15/2022]
Abstract
This report describes a simple venous reconstructive technique that results in an autogenous vascular graft with sufficient luminal diameter for replacing the vena cava. The majority of vena caval reconstructions are performed using prosthetic grafts; however, graft infection is a concern in clean-contaminated hepatobiliary and retroperitoneal resections.
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Affiliation(s)
- Derek A DuBay
- Division of General Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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Cho SW, Marsh JW, Geller DA, Holtzman M, Zeh H, Bartlett DL, Gamblin TC. Surgical management of leiomyosarcoma of the inferior vena cava. J Gastrointest Surg 2008; 12:2141-8. [PMID: 18841423 DOI: 10.1007/s11605-008-0700-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Accepted: 09/08/2008] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor for which en bloc resection offers the only chance of cure. Due to its rarity, however, optimal strategies for the management of the primary tumor and subsequent recurrences are not well defined. METHODS We performed a retrospective review of patients who underwent surgical resection of IVC leiomyosarcoma. We evaluated clinical presentations, operative techniques, patterns of recurrence and survival. RESULTS From 1990 to 2008, nine patients (four females) were identified. Median age was 55 years (40-76). Presentations included abdominal pain (n = 5), back pain (n = 2), leg swelling (n = 4) and abdominal mass (n = 2). Pre-operative imaging studies showed tumor location to be from the right atrium to renal veins (n = 1), retrohepatic (n = 5), and from hepatic veins to the iliac bifurcations (n = 3). En bloc resection included right nephrectomy (n = 5), right adrenalectomy (n = 4), pancreaticoduodenectomy (n = 1), right hepatic trisectionectomy (n = 1) and right hemicolectomy (n = 1). The IVC was ligated in six patients, and a prosthetic graft was used for IVC reconstruction in three patients. Resection margins were negative in seven cases. Median length of stay was 12 days (range, 6-22 days). Major morbidity included renal failure (n = 1) and there was one post-operative mortality. Five patients had leg edema post-operatively, four of whom had IVC ligation. Median survival was 47 months (range, 1-181 months). Four patients had recurrence and the median time to recurrence was 14 months (range, 3-25 months). Two patients underwent successful resection of recurrence. CONCLUSIONS Curative resection of IVC leiomyosarcoma can lead to long-term survival. However, recurrence is common, and effective adjuvant treatments are needed. In selected cases, aggressive surgical treatment of recurrence should be considered.
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Affiliation(s)
- S W Cho
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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31
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Duty B, Daneshmand S. Venous resection in urological surgery. J Urol 2008; 180:2338-42; discussion 2342. [PMID: 18930288 DOI: 10.1016/j.juro.2008.08.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Indexed: 11/15/2022]
Abstract
PURPOSE Complete removal of retroperitoneal and pelvic tumors may require resection or ligation of major retroperitoneal, pelvic and mesenteric venous structures. We provide an overview of venous anatomy and collateral drainage, and review the veins that can be safely resected. MATERIALS AND METHODS We reviewed major anatomical texts, and performed a directed MEDLINE literature search of retroperitoneal, pelvic and mesenteric venous anatomy. Resection and reconstruction of these vessels were also reviewed with an emphasis on collateral blood flow and post-resection sequelae. RESULTS The infrarenal inferior vena cava, iliac veins, left renal vein, lumbar veins, inferior mesenteric vein and splenic vein may be resected or ligated without reconstruction. Resection of the right renal vein results in renal demise in the majority of instances. The portal vein may not be resected without reconstruction. Venous reconstruction may be performed with autologous or synthetic graft material. CONCLUSIONS Most major veins in the body can be safely resected or ligated with minimal sequelae. However, it is imperative to understand venous anatomy and collateral blood flow to minimize intraoperative and postoperative complications.
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Affiliation(s)
- Brian Duty
- Division of Urology and Renal Transplantation, Section of Urologic Oncology, Oregon Health & Science University, Portland, Oregon 97239, USA
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32
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Bertini R, Suardi N, Marone EM, Roscigno M, Petralia G, Strada E, Cestari A, Arrigoni G, Guazzoni G, Montorsi F, Chiesa R, Rigatti P. Pregnant Woman Presenting with a Gross Retroperitoneal Mass: Surgical Treatment with Caval Replacement. Eur Urol 2008; 54:677-80. [DOI: 10.1016/j.eururo.2008.06.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Accepted: 06/13/2008] [Indexed: 11/16/2022]
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Spinelli A, Schumacher G, Benckert C, Sauer IM, Schmeding M, Glanemann M, Neumann UP, Jonas S, Neuhaus P. Surgical treatment of a leiomyosarcoma of the inferior vena cava involving the hepatic and renal veins confluences: Technical aspects. Eur J Surg Oncol 2008; 34:831-5. [PMID: 17321715 DOI: 10.1016/j.ejso.2007.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Accepted: 01/10/2007] [Indexed: 10/23/2022] Open
Affiliation(s)
- A Spinelli
- Department of General, Visceral and Transplantation Surgery, Charitè-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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Fiore M, Locati P, Mussi C, Guarino A, Piva L, Santinami M, Gronchi A. Banked venous homograft replacement of the inferior vena cava for primary leiomyosarcoma. Eur J Surg Oncol 2008; 34:720-4. [PMID: 17097262 DOI: 10.1016/j.ejso.2006.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Accepted: 10/03/2006] [Indexed: 10/23/2022] Open
Affiliation(s)
- M Fiore
- Department of Surgery, Istituto Nazionale per lo studio e la cura dei Tumori, via Venezian 1, 20133 Milan, Italy
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Zini L, Destrieux-Garnier L, Leroy X, Villers A, Haulon S, Lemaitre L, Koussa M. Renal Vein Ostium Wall Invasion of Renal Cell Carcinoma With an Inferior Vena Cava Tumor Thrombus: Prediction by Renal and Vena Caval Vein Diameters and Prognostic Significance. J Urol 2008; 179:450-4; discussion 454. [DOI: 10.1016/j.juro.2007.09.042] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Laurent Zini
- Department of Urology, Lille University Hospital, Lille, Cedex, France
| | | | - Xavier Leroy
- Department of Pathology, Lille University Hospital, Lille, Cedex, France
| | - Arnauld Villers
- Department of Urology, Lille University Hospital, Lille, Cedex, France
| | - Stephan Haulon
- Department of Vascular Surgery, Lille University Hospital, Lille, Cedex, France
| | - Laurent Lemaitre
- Department of Radiology, Lille University Hospital, Lille, Cedex, France
| | - Mohamad Koussa
- Department of Vascular Surgery, Lille University Hospital, Lille, Cedex, France
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36
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Ohwada S, Izumi M, Tanahashi Y, Kawate S, Hamada K, Tsutsumi H, Horiguchi J, Koibuchi Y, Takahashi T, Yamada M. Combined liver and inferior vena cava resection for adrenocortical carcinoma. Surg Today 2007; 37:291-7. [PMID: 17387560 DOI: 10.1007/s00595-006-3404-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 10/11/2006] [Indexed: 12/14/2022]
Abstract
PURPOSE 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.
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Affiliation(s)
- Susumu Ohwada
- Department of Surgery, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Jibiki M, Inoue Y, Sugano N, Iwai T, Katou T. Tumor thrombectomy without bypass for low-grade malignant tumors extending into the inferior vena cava: report of two cases. Surg Today 2007; 36:465-9. [PMID: 16633754 DOI: 10.1007/s00595-005-3175-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Accepted: 11/15/2005] [Indexed: 10/24/2022]
Abstract
Endometrial stromal sarcoma (ESS) rarely extends into the inferior vena cava (IVC). Two cases of ESS extending into the IVC were encountered. In the first case a low-grade sarcoma and cavography revealed the tumor thrombus to extend to just below the left renal vein from the right internal iliac vein, and the IVC was patent. A tumor thrombectomy was accomplished to prevent pulmonary embolism (PE) and to achieve a good prognosis. The second case was also a low-grade sarcoma. Abdominal computed tomography scanning revealed a large thrombus extending into the IVC just below the hepatic vein. A tumor thrombectomy with an IVC resection was performed. The postoperative course was uneventful for both cases. Aggressive surgical treatment is thus recommended to excise a tumor thrombus with or without an IVC resection in patients with ESS of low-grade malignancy extending into the IVC to prevent sudden death due to PE.
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Affiliation(s)
- Masatoshi Jibiki
- Department of Vascular and Applied Surgery, Tokyo Medical and Dental University, Graduate School, 1-5-45 Yushima, Tokyo, 113-8519, Japan
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38
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Azoulay D, Andreani P, Maggi U, Salloum C, Perdigao F, Sebagh M, Lemoine A, Adam R, Castaing D. Combined liver resection and reconstruction of the supra-renal vena cava: the Paul Brousse experience. Ann Surg 2006; 244:80-8. [PMID: 16794392 PMCID: PMC1570596 DOI: 10.1097/01.sla.0000218092.83675.bc] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Liver tumors with inferior vena cava (IVC) involvement may require combined resection of the liver and IVC. This approach, with its high surgical risks and poor long-term prognosis, was precluded until the development of neoadjuvant chemotherapy, portal vein embolization, reinforced vascular prostheses, and technical advances in liver transplantation. METHODS We reviewed 22 cases of hepatectomy with retrohepatic IVC resection and reconstruction. The patients had a median age of 51.5 years (range, 32.8-75.3 years). Indications for resection were: liver metastases (n = 9), cholangiocarcinoma (n = 8), hepatocellular carcinoma (n = 2), other cancers (n = 3). The liver resections carried out included 18 first, 3 second, and one third hepatectomy. Segment 1 (caudate lobe) was included in the specimen in 19 cases (86%). Resection concerned 1 to 6 liver segments (median = 5.0). Vascular control was achieved by vascular exclusion of the liver preserving the caval flow (n = 1), standard vascular exclusion of the liver (n = 12), in situ cold perfusion of the liver (n = 9). Ex situ surgery was not necessary in any case. Venovenous bypass was used in 12 cases. The IVC was reconstructed with a ringed Gore-Tex tube graft (n = 10), primarily (n = 8), or by caval plasty (n = 4). A main hepatic vein was reimplanted in 6 cases: into the native IVC (n = 4) or into a Gore-Tex tube graft (n = 2). RESULTS One patient died (4.5%) due to catheter infection, 7 days after in situ cold perfusion with replacement of the vena cava. Eight patients (36%) had no complications and 14 patients (64%) had 23 complications. In all but 1 case, the complications were transient and successfully controlled. The patients stayed in intensive care for 3.3 +/- 2.0 days and in the hospital for 17.7 +/- 7.8 days. All vascular reconstructions were patent at last follow-up. With median follow-up of 19 months, 10 patients died of tumor recurrence and eleven were alive with (n = 5) or without (n = 6) disease. Actuarial 1-, 3-, and 5-year survival rates were 81.8%, 38.3%, and 38.3%, respectively. CONCLUSIONS IVC resection and reconstruction combined with liver resection can be safely performed in selected patients. The lack of alternative treatments and the spontaneous poor prognosis justify this approach, provided that surgery is carried out at a center specialized in both liver surgery and liver transplantation. The development of adjuvant chemotherapy regimens is required to improve the long-term results of this salvage surgery.
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Affiliation(s)
- Daniel Azoulay
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France.
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39
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Fueglistaler P, Gurke L, Stierli P, Obeid T, Koella C, Oertli D, Kettelhack C. Major Vascular Resection and Prosthetic Replacement for Retroperitoneal Tumors. World J Surg 2006; 30:1344-9. [PMID: 16773255 DOI: 10.1007/s00268-005-0555-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Involvement of major vascular structures has been considered a limiting factor for resecting advanced tumors. The objective of this study was to evaluate the outcome after concomitant retroperitoneal tumor and vascular resection with prosthetic replacement of the aorta/vena cava. METHODS The authors reviewed a 5-year series of eight patients with a median age of 50 years (range 11-68 years) who had undergone resection of a retroperitoneal tumor and concomitant resection and replacement of the abdominal aorta, inferior vena cava, or both. The histologic diagnoses were sarcoma (five patients), teratoma (one), transitional cell carcinoma (one), and ganglioneuroma (one). The main outcome measures were early (<30 days) and late (>or=30 days) surgical morbidity and mortality. Secondary endpoints were vascular graft patency and tumor-free survival. Two patients underwent combined graft replacement of the aorta and vena cava. Single aortic and vena cava graft replacement were each done in three patients. RESULTS Two patients showed early surgical morbidity necessitating reoperation for a thrombotic graft occlusion. No patient died during the early course of the follow-up. During a median follow-up of 14 months (range 1-56 months), two patients had late surgical morbidity. The median tumor-free survival for patients with malignancy was 14 months (range 1-54 months). One patient developed locoregional tumor recurrence, and two developed distant metastases. The median survival for patients with malignancy was 14 months (range 1-60 months). CONCLUSIONS An aggressive surgical approach for otherwise unresectable retroperitoneal tumors with vascular resection and prosthetic vascular replacement is justified in selected cases and has acceptable morbidity and mortality.
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Affiliation(s)
- Philipp Fueglistaler
- University Centre for Vascular Surgery, Aarau/Basel, and Department of General Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
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Hasegawa T, Kimura T, Ihara Y, Tazuke Y, Yoneda A, Kusafuka T, Fukuzawa M, Okuyama H, Inoue M. Living-related liver transplantation with removal of inferior vena cava for unresectable hepatoblastoma. Pediatr Transplant 2006; 10:521-4. [PMID: 16712615 DOI: 10.1111/j.1399-3046.2006.00516.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a case of a two-yr-old boy with hepatoblastoma resectable only by total hepatectomy including the vena cava. Successful LTx was performed with a living donor segment without vena cava reconstruction. The tumor was located in the bilateral lobe, surrounding the IVC. In spite of the high-dose chemotherapy, the tumor did not become resectable. LTx was performed using left lateral segment after removal of the IVC combined with total hepatectomy. Because the collaterals were well developed, the patient tolerated the procedure well. The serum AFP level decreased from 186 699 to 8 ng/mL in 11 months after LTx without local recurrence or distant metastasis.
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Affiliation(s)
- Toshimichi Hasegawa
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan.
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41
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Smaldone MC, Cannon GM, Hrebinko RL. Resection of recurrent inferior vena cava tumor after radical nephrectomy for renal cell carcinoma. Urology 2006; 67:1084.e5-7. [PMID: 16698379 DOI: 10.1016/j.urology.2005.10.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Revised: 10/03/2005] [Accepted: 11/01/2005] [Indexed: 10/24/2022]
Abstract
Management of recurrent tumor in the inferior vena cava (IVC) after radical nephrectomy is surgically challenging. We report 3 cases of recurrent renal cell carcinoma within the IVC managed by three different surgical techniques. One patient was treated with tumor thrombus removal and primary cavotomy closure. The second patient was treated with IVC ligation and removal without vascular reconstruction. A third patient was treated with IVC wall excision and placement of a bovine pericardium graft. Although technically difficult, repeat resection of IVC tumor recurrence after nephrectomy for renal cell carcinoma is an acceptable method of treatment.
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Affiliation(s)
- Marc C Smaldone
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
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Chiche L, Dousset B, Kieffer E, Chapuis Y. Adrenocortical carcinoma extending into the inferior vena cava: Presentation of a 15-patient series and review of the literature. Surgery 2006; 139:15-27. [PMID: 16364713 DOI: 10.1016/j.surg.2005.05.014] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Revised: 05/15/2005] [Accepted: 05/20/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Involvement of the inferior vena cava (IVC) is a controversial risk factor for surgical treatment of adrenocortical carcinoma (ACC). This study aims to assess the outcome of an aggressive surgical policy for ACC extending into the IVC and discuss treatment strategies based on a review of the literature. METHODS Over a 25-year period, 15 patients were treated for ACC extending into the IVC. The upper limit of the extension was the infrahepatic IVC in 2 patients, retrohepatic IVC in 6, and suprahepatic IVC in 7, including 4 with extension into the right atrium. Seven patients presented with concurrent metastases. The operative technique was thrombectomy (n = 13), partial resection with direct closure (n = 1), and total resection with replacement of the IVC (n = 1). Venous control was achieved by caval clamping alone (n = 4), hepatic vascular exclusion (n = 5), and the use of normothermic cardiopulmonary bypass or hypothermic circulatory arrest (n = 6). RESULTS Two patients died postoperatively. Ten patients died of metastatic complications at 4 to 31 months. Median survival time was 8 months. Three patients were still alive after 24, 25, and 45 months of follow-up, one of whom was reoperated at 17 months for a local recurrence. No evidence of recurrent intravenous involvement was found during follow-up in any patient in whom complete resection was achieved. CONCLUSIONS Our findings suggest that surgical treatment can be effective for management of ACC with extension into the IVC. Long-term prognosis is poor owing to delay in diagnosis, frequent associated metastatic disease and lack of effective adjuvant treatment.
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Affiliation(s)
- Laurent Chiche
- Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
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Miyata R, Shimazu M, Kawachi S, Tanabe M, Aiura K, Wakabayashi G, Ueda M, Sakuma M, Kitajima M. Left trisegmentectomy and combined resection of the inferior vena cava, without reconstruction, for giant cystadenocarcinoma of the liver. ACTA ACUST UNITED AC 2005; 12:272-6. [PMID: 15995820 DOI: 10.1007/s00534-004-0967-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Accepted: 12/22/2004] [Indexed: 12/01/2022]
Abstract
A 54-year-old woman with giant liver cystadenocarcinoma underwent left trisegmentectomy with combined resection of the inferior vena cava (IVC) and the right hepatic vein. As a result, only the right inferior hepatic vein was preserved as a drainage vein. Because the perivertebral plexus and the azygos vein were both well developed, neither veno-venous bypass nor IVC reconstruction was performed. The developed collateral veins acted as the venous drainage pathway to maintain a stable systemic circulation. On the seventh postoperative day, portal vein flow dramatically decreased and the patient tended to liver failure. Prostaglandin E(1) (PGE(1)) was administrated via the superior mesenteric artery. The portal flow then gradually increased and liver failure was avoided. Six months after the operation, she was re-admitted due to obstructive jaundice and presented with complete stenosis of the common bile duct (CBD). The jaundice persisted and liver dysfunction progressed. The patient died seven months after the operation. The confluence of the right inferior vein and the IVC could have been deformed, causing outflow blockade. The intrinsic shunt was not good enough to act as the drainage pathway, and IVC reconstruction may have been needed.
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Affiliation(s)
- Ryohei Miyata
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Nardo B, Ercolani G, Montalti R, Bertelli R, Gardini A, Beltempo P, Puviani L, Pacilè V, Vivarelli M, Cavallari A. Hepatic resection for primary or secondary malignancies with involvement of the inferior vena cava: is this operation safe or hazardous? J Am Coll Surg 2005; 201:671-9. [PMID: 16256908 DOI: 10.1016/j.jamcollsurg.2005.06.272] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Revised: 06/23/2005] [Accepted: 06/29/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study evaluated surgical techniques and results of patients with tumors who had undergone liver resection with partial resection and reconstruction of the IVC. STUDY DESIGN We performed a retrospective analysis of all patients who underwent combined liver and IVC resection and reconstruction at a single institution. We identified 19 patients and two categories of tumors, primary (n = 8) and metastatic (n = 11). In 12 patients, a direct suture of the IVC was performed; in 3 patients a pericardium bovine patch was applied; in another 4 patients the IVC was replaced by PTFEt prosthesis. In nine patients, total hepatic vascular occlusion was required. RESULTS Perioperative mortality was 5.9%, related to technical complications and hepatic insufficiency. Postoperative morbidity was 57.9%. Median survival time was 32 months (range 3 to 125 months). The 1-, 2-, and 5-year cumulative survival rates were 78.9%, 68%, and 49.1%, respectively. Tumor recurrence appeared in 13 patients and was the main cause of death (55.5%). Among the seven patients suffering from hepatocellular carcinoma, three are still alive at 31, 60, and 125 months after resection. In this group, 1-, 2-, and 5-year survival rates were 71.4%, 57.1%, and 38.1%. Among the 11 patients resected for colorectal liver metastases, the 1-, 2-, and 5-year survival rates were 81.8%, 62.3%, and 51.9%, respectively. CONCLUSIONS Liver resection combined with IVC resection and reconstruction is a feasible procedure that can be performed with an acceptable operative risk leading to longterm outcome in selected patients.
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Affiliation(s)
- Bruno Nardo
- General Surgery Unit, Department of Surgery, Intensive Care Unit and Transplantations, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Czauderna P, Otte JB, Aronson DC, Gauthier F, Mackinlay G, Roebuck D, Plaschkes J, Perilongo G. Guidelines for surgical treatment of hepatoblastoma in the modern era--recommendations from the Childhood Liver Tumour Strategy Group of the International Society of Paediatric Oncology (SIOPEL). Eur J Cancer 2005; 41:1031-6. [PMID: 15862752 DOI: 10.1016/j.ejca.2005.02.004] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2004] [Revised: 02/11/2005] [Accepted: 02/17/2005] [Indexed: 12/14/2022]
Abstract
Cisplatin-containing chemotherapy and complete surgical resection are both crucial in the cure of hepatoblastoma. Radical resection can be obtained either conventionally by partial hepatectomy or with orthotopic liver transplant, but the surgical approach to hepatoblastoma differs considerably across the world. Our main aim in this paper is to present the surgical recommendations of the Childhood Liver Tumour Strategy Group of the International Society of Paediatric Oncology (SIOPEL), as well as to stimulate international debate on this issue. We discuss biopsy, verification of resectability, resection principles, indications and potential contraindications for orthotopic liver transplant, as well as thoracic surgery for pulmonary metastases. We suggest that heroic liver resections with a high probability of leaving residual tumour should be avoided whenever possible. In such cases primary orthotopic liver transplant should be considered. Superior survival rates in hepatoblastoma patients who have received a primary transplant after a good response to chemotherapy support the strategy of avoiding partial hepatectomy in cases where radical resection appears difficult and doubtful. We recommend early referral to a transplant surgeon in cases of: (i) multifocal or large solitary PRETEXT IV (PRE Treatment EXTent of disease scoring system) hepatoblastoma involving all four sectors of the liver and (ii) unifocal, centrally located tumours involving main hilar structures or main hepatic veins. Because complete tumour resection is a prerequisite for cure, any strategy leading to an increased resection rate will result in improved survival. We advise the more frequent use of orthotopic liver transplant, as well as the standardisation of techniques for partial liver resection. These guidelines should not be seen as final, but rather as a starting point for further discussion between the various national and international liver tumour study groups.
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Affiliation(s)
- Piotr Czauderna
- Department of Paediatric Surgery, Medical University of Gdansk, ul. Nowe Ogrody 1-6, Gdansk 80-803, Poland
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Dew J, Hansen K, Hammon J, McCoy T, Levine EA, Shen P. Leiomyosarcoma of the Inferior Vena Cava: Surgical Management and Clinical Results. Am Surg 2005; 71:497-501. [PMID: 16044929 DOI: 10.1177/000313480507100609] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Leiomyosarcoma of the inferior vena cava (IVC) is a rare lesion with less than 300 cases reported. Optimal management and long-term outcomes are not well described. From August 1984 to June 2004, eight patients with leiomyosarcoma of the IVC were treated at our institution. Clinical and pathologic data, surgical management, and outcomes were assessed. Eight cases were identified (4 males) with a median age of 52 (range 29–66). Presenting symptoms included abdominal pain (n = 5, 63%), lower extremity edema (n = 2, 25%), and palpable mass (n = 2, 25%). Tumor location was between the renal and iliac veins (low) (n = 4, 50%), between the hepatic and renal veins (middle) (n = 3, 38%), and above the hepatic veins with right atrial extension (high) (n = 1, 12%). Two patients with preoperative IVC occlusion were managed with tumor excision and IVC ligation. Three patients had primary repair of the IVC after tumor excision. A polytetrafluorothylene (PTFE) tube graft was used for IVC reconstruction in three cases. There was no postoperative mortality. Postoperative morbidity included deep venous thrombosis (DVT) (n = 1), lower extremity edema (mild n = 1; moderate n = 1), GI bleed (n = 1), and chronic renal insufficiency (n = 1). One patient is currently receiving adjuvant chemotherapy. Four patients received chemotherapy after recurrence, and one received palliative radiation therapy as well. Median survival to this point was 60 months with a median follow-up of 39 months. The 5-year overall survival and disease-free survival was 31 per cent for both (CI 0.1–1.0). The type of IVC reconstruction had no effect on survival ( P = 0.22). Recurrence was discovered in four patients (50%) at a median time of 14 months. Resection of leiomyosarcoma of the IVC should be attempted whenever feasible. The management of the IVC can be managed with primary repair, ligation, or prosthetic graft. Long-term survival is possible if complete resection can be achieved.
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Affiliation(s)
- Jason Dew
- Wake Forest University School of Medicine, Department of Surgery, Surgical Oncology, Vascular Surgery Service, Winston-Salem, North Carolina 27157, USA
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Yoshidome H, Takeuchi D, Ito H, Kimura F, Shimizu H, Ambiru S, Togawa A, Ohtsuka M, Kato A, Miyazaki M. Should the inferior vena cava be reconstructed after resection for malignant tumors? Am J Surg 2005; 189:419-24. [PMID: 15820453 DOI: 10.1016/j.amjsurg.2005.01.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2003] [Revised: 06/23/2004] [Accepted: 06/23/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND Caval replacement after circumferential resection of the inferior vena cava remains controversial. The aim of the current study is to determine whether or not inferior vena cava replacement should be performed. METHODS We reviewed 36 cases undergoing resection of the inferior vena cava concomitant with resection of malignant neoplasms. Our criteria for circumferential resection of the inferior vena cava were half or more of the circumference of the vessel wall invaded by tumor, a primary tumor of the caval wall, or massive intraluminal tumor thrombus suspected of adhering to the caval wall. We detailed 10 patients undergoing circumferential resection of the inferior vena cava. RESULTS Most of patients who did not undergo replacement of the inferior vena cava showed no sign of swelling of the lower limbs, but one showed persistent leg edema with oliguria. This patient had poor development of collateral circulation and mild obstruction of the inferior vena cava before surgery. Two patients who underwent replacement of inferior vena cava had no venous sequelae, although they had poor development of collateral circulation before surgery. CONCLUSION Caval replacement after circumferential resection of the inferior vena cava may be necessary in patients who have preoperative poor development of collateral circulation or who have oliguria or unstable hemodynamics intraoperatively.
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Affiliation(s)
- Hiroyuki Yoshidome
- Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba 260-0856 Japan
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Hardwigsen J, Balandraud P, Ananian P, Saïsse J, Le Treut YP. Leiomyosarcoma of the retrohepatic portion of the inferior vena cava: clinical presentation and surgical management in five patients. J Am Coll Surg 2005; 200:57-63. [PMID: 15631921 DOI: 10.1016/j.jamcollsurg.2004.09.035] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Revised: 09/02/2004] [Accepted: 09/02/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND Leiomyosarcoma (LMS) is a rare primary soft tissue sarcoma arising from the inferior vena cava (IVC). For LMS involving the retrohepatic portion of IVC there are limited published data about tumor features, surgical strategies, and IVC replacement. STUDY DESIGN Clinical data, surgical procedures, and pathologic features of five consecutive patients referred for IVC-LMS, in 5 years, were reviewed. A complete surgical resection of the tumor was performed in each patient and IVC replacement used expanded polytetrafluoroethylene grafts. RESULTS Abdominal pain (n = 4) and palpable flank mass (n = 3) were the most frequent signs. To assure a complete tumoral exeresis, adjacent organ resection included hepatectomy (n = 4), extended right nephrectomy (n = 3), and right adrenalectomy (n = 1). Prosthetic IVC reconstruction was performed in four patients, three times associated with arteriovenous fistula. Median postoperative stay was 18 days. No prosthetic-related complication was observed, venous insufficiency sequela did not occur. Tumoral clearance was achieved in all patients, and direct tumoral involvement of the liver was less frequent than for kidney. Three patients died at a median followup of 34 months, two are alive and disease-free at 34 and 44 months. CONCLUSIONS LMS of the IVC is characterized by locally advanced status at the time of diagnosis. A radical tumoral resection associated with liberal use of venous prosthetic replacement may offer a chance for cure and good quality of life in palliative situations.
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Affiliation(s)
- Jean Hardwigsen
- Department of Surgery and Liver Transplantation, Hôpital de la Conception, 147 Boulevard Baille, 13385 Marseilles Cedex 5, France
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Kikumori T, Imai T, Kaneko T, Sugimoto H, Shibata A, Hibi Y, Nakao A. Intracaval endovascular ultrasonography for large adrenal and retroperitoneal tumors. Surgery 2004; 134:989-93; discussion 993-4. [PMID: 14668732 DOI: 10.1016/j.surg.2003.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND An accurate diagnosis of inferior vena cava (IVC) invasion is important in deciding the surgical strategy for a large adrenal tumor. We investigated the diagnostic value of intracaval endovascular ultrasonography (ICEUS) for invasion of the IVC by a large adrenal tumor. METHODS Nine of 163 patients with adrenal and retroperitoneal tumors underwent ICEUS between 1993 and 2002. Intravascular ultrasonography was performed through the right femoral vein with the use of an 8Fr, 20-MHz transducer. The diagnostic criterion for detecting IVC invasion with ICEUS was identification of destruction of a single echogenic layer of the IVC wall or identification of an intracaval tumor mass. The ICEUS finding was confirmed by pathologic examination. RESULTS The mean diameter of the tumors in 9 patients undergoing ICEUS and resection was 12.6 cm (range, 8.6-16 cm). Pathologic diagnosis varied: adrenocortical carcinoma, 4; malignant pheochromocytoma, 1; leiomyosarcoma, 1; metastatic lung cancer, 1; paraganglioma, 1; and neurilemmoma, 1. Vascular invasion was identified in 2 patients by ICEUS and confirmed by examination of resected specimens. The sensitivity, specificity, and positive predictive values of ICEUS for the diagnosis of the IVC invasion were 100%, 100%, and 100%, respectively. However, these values for computed tomography were 100%, 14%, and 25%, respectively; and for cavography, 100%, 57%, and 40%, respectively. CONCLUSIONS ICEUS provides confirmatory information regarding tumor invasion of the IVC. This modality also can assist in formulating an operative strategy for large adrenal or retroperitoneal tumors.
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Affiliation(s)
- Toyone Kikumori
- Department of Surgery II, Nagoya University School of Medicine, 65 Tsueumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Lam BK, Pettersson GB, Vogt DP. Urgent inferior vena cava replacement with an autologous pericardium tube graft. J Thorac Cardiovasc Surg 2004; 126:2101-3. [PMID: 14688740 DOI: 10.1016/j.jtcvs.2003.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- B-Khanh Lam
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio 44195, USA
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