Special therapeutic procedures
The involvement of the inferior vena cava in tumoral processes has been considered for a very long time an unquestionable reason for surgincal inoperability or unresectability. The great difficulty of this technique and the unclear risk/benefit relation are important reasons that determine this attitude.
The important progress made in the last two decades (most of them thanks to liver transplant) and the use of new prosthetic materials have permitted the performance of resections of the vena cava with or without substitute prosthesis as a therapeutical alternative for patients with locally-advanced tumoral diseases. Thus, a therapeutical approach may be offered to a particular number of patients with a curative intention.
Our experience in resection of the inferior vena cava following different process goes up to 20 different cases. The indications for their performance were:
- Liver metastasis from colorectal carcinoma
- Intrahepatic cholangiocarcinoma
- Renal carcinoma
- Inferior vena cava tumoral thrombosis from renal carcinoma
- Inferior vena cava primary tumors
- Retroperitoneal tumors with involvement of the inferior vena cava
- Liver hydatid disease with involvement of the inferior vena cava and consequent thrombosis
In 40% of the cases described, a resection of the inferior vena cava and a restitution of the systemic vascular flow were performed thanks to the a ring prosthesis with a diameter of 20 mm. In most cases, a saphenous-femoral arterio-venous fistula was added in order to increase venous flow in the prosthesis.
The results obtained, in terms of surgical morbimortality, permeability of the substitute prosthesis and long, medium and short term survival rates, justify this kind of surgical procedures in a particular number of patients in which a venous excision might be required for the complete resection of the tumor. As long as the characteristics of the tumor require, following chemoradiotherapy completes the therapeutic treatment.
Inferior vena cava tumoral thrombosis from renal carcinoma.
Cavectomy from the origin of the iliac veins to the liver veins.
Vascular primary retroperitoneal tumor with vascular origin. Leiomyosarcoma of inferior vena cava.
Tumor resection with substitute prosthesis of the inferior vena cava and reimplant of right renal vein.