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Single-Centre Experience of Supra-Renal Vena Cava Resection and Reconstruction

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Abstract

Background

Tumours involving the supra-renal segment of IVC have dismal prognosis if left untreated. Currently, aggressive surgical management is the only potentially curative treatment but is associated with relatively high morbidity and mortality. This study aims to evaluate perioperative factors, associated with adverse postoperative outcomes, based on the perioperative characteristics and type of IVC reconstruction.

Methods

We identified 44 consecutive patients, who underwent supra-renal IVC resection with a mean age of 57.3 years. Isolated resection of IVC was performed in four patients, concomitant liver resection was performed in 27 patients and other associated resection in 13 patients. Total vascular exclusion was applied in 21 patients, isolated IVC occlusion in 11 patients. Neither venovenous bypass (VVB) nor hypothermic perfusion was used in any of the cases.

Results

The mean operative time was 205 min (150–324 min) and the mean estimated blood loss was 755 ml (230–4500 ml). Overall morbidity was 59% and major complications (Dindo-Clavien ≥ III) occurred in 11 patients (25%). The 90-day mortality was 11% (5pts). Intraoperative haemotransfusion was significantly associated with postoperative general complications (p < 0,001). With a mean follow-up of 26.2 months, the actuarial 1-, 3- and 5-year survival is 69%, 34%, and 16%, respectively.

Conclusions

IVC resection and reconstruction in the aspect of aggressive surgical management of malignant disease confers a survival advantage in patients, often considered unresectable. When performed in experienced centres it is associated with acceptable morbidity and mortality.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Clinic of HPB Surgery and Liver Transplantation, Military Medical Academy, 3 Georgi Sofiiski Street, Sofia, 1606, Bulgaria

    Nikola Vladov, Radoslav Kostadinov, Vassil Mihaylov, Maria Yakova & Tsvetan Trichkov

  2. First Clinic of Abdominal Surgery, Military Medical Academy, 3 Georgi Sofiiski Street, Sofia, 1606, Bulgaria

    Ivelin Takorov & Tsonka Lukanova

  3. Clinic of Anaesthesiology, Reanimation and Intensive Treatment, Military Medical Academy, 3 Georgi Sofiiski Street, 1606, Sofia, Bulgaria

    Evelina Odisseeva

  4. Clinic of Endoscopic, Endocrine Surgery and Coloproctology, Military Medical Academy, 3 Georgi Sofiiski Street, 1606, Sofia, Bulgaria

    Ventsislav Mutafchiyski

Authors
  1. Nikola Vladov
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  2. Radoslav Kostadinov
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  3. Vassil Mihaylov
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  4. Ivelin Takorov
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  5. Tsonka Lukanova
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  6. Maria Yakova
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  7. Tsvetan Trichkov
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  8. Evelina Odisseeva
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  9. Ventsislav Mutafchiyski
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Contributions

Nikola Vladov was involved in study concept and design; Maria Yakova, Tsvetan Trichkov contributed to acquisition of data ; Radoslav Kostadinov, Vassil Mihaylov, Evelina Odisseeva were involved in analysis and interpretation of data; Radoslav Kostadinov, Ivelin Takorov contributed to drafting of manuscript; Tsonka Lukanova, Ventsislav Mutafchiyski, Nikola Vladov were involved in critical revision of manuscript.

Corresponding author

Correspondence to Radoslav Kostadinov.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was waived by the local Ethics Committee of Military Medical Academy—Sofia given the retrospective nature of the study and all the procedures being performed were part of the routine care.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Vladov, N., Kostadinov, R., Mihaylov, V. et al. Single-Centre Experience of Supra-Renal Vena Cava Resection and Reconstruction. World J Surg 45, 2270–2279 (2021). https://doi.org/10.1007/s00268-021-06048-w

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  • DOI: https://doi.org/10.1007/s00268-021-06048-w

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