Nikola Vladov1, Radoslav Kostadinov2, Vassil Mihaylov1, Ivelin Takorov3, Tsonka Lukanova3, Maria Yakova1, Tsvetan Trichkov1, Evelina Odisseeva4, Ventsislav Mutafchiyski5. 1. Clinic of HPB Surgery and Liver Transplantation, Military Medical Academy, 3 Georgi Sofiiski Street, Sofia, 1606, Bulgaria. 2. Clinic of HPB Surgery and Liver Transplantation, Military Medical Academy, 3 Georgi Sofiiski Street, Sofia, 1606, Bulgaria. radokost@gmail.com. 3. First Clinic of Abdominal Surgery, Military Medical Academy, 3 Georgi Sofiiski Street, Sofia, 1606, Bulgaria. 4. Clinic of Anaesthesiology, Reanimation and Intensive Treatment, Military Medical Academy, 3 Georgi Sofiiski Street, 1606, Sofia, Bulgaria. 5. Clinic of Endoscopic, Endocrine Surgery and Coloproctology, Military Medical Academy, 3 Georgi Sofiiski Street, 1606, Sofia, Bulgaria.
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.
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.
Authors: M Miyazaki; H Ito; K Nakagawa; S Ambiru; H Shimizu; A Okuno; Y Nukui; H Yoshitomi; K Kusashio; S Furuya; N Nakajima Journal: Am J Surg Date: 1999-04 Impact factor: 2.565