Document Detail


Resection and reconstruction of the inferior vena cava for neoplasms.
MedLine Citation:
PMID:  22590663     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Nikola Nikolov Vladov; Vassil Ivanov Mihaylov; Nikolai Vassilev Belev; Ventzislav Metodiev Mutafchiiski; Ivelin Rumenov Takorov; Sergei Kirilov Sergeev; Evelina Hristova Odisseeva
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  World journal of gastrointestinal surgery     Volume:  4     ISSN:  1948-9366     ISO Abbreviation:  World J Gastrointest Surg     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-05-16     Completed Date:  2012-10-02     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101532473     Medline TA:  World J Gastrointest Surg     Country:  China    
Other Details:
Languages:  eng     Pagination:  96-101     Citation Subset:  -    
Affiliation:
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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