Surgery of the inferior vena cava for tumor-related obstruction

Abstract

Kidney tumors and pheochromocytomas of the adrenal gland may extend into the inferior vena cava (IVC) or even the right atrium. In these cases, curative surgery frequently requires partial resection of the IVC. From 1992 to 1995, 8 patients (6 kidney tumors, 2 pheochromocytomas of the adrenal gland) underwent tumor surgery with concomitant IVC resection. Four patients had tumor growth into the right atrium. Surgery was carried out during hypothermic circulatory arrest (n=4) using veno-venous bypass from the IVC to the jugular vein (n=2), or by simply clamping the IVC (n=2). In 6 patients the IVC was reconstructed using a PTFE prosthesis (n=2) or patch (n=4), in 2 patients the IVC was closed by a running suture only. All patients were discharged home 10–23 days after surgery (mean 13 days). During the follow-up (mean 23 months), 6 patients were in good clinical condition and without evidence of tumor recurrence up to 44 months after surgery and 2 patients died of metastases (16 and 17 months). Refinements of surgical techniques combined with a multidisciplinary approach involving vascular surgeons, cardiac surgeons, and urologists allow successful treatment of advanced tumor stages with IVC involvement, formerly considered a contraindication for surgery. The aggressive surgical approach is warranted not only for relief of symptoms, and acceptable survival rates can be achieved; even cure of the disease is possible.