Background: On occasion complete resection of the inferior vena cava (IVC) is necessary to obtain a negative surgical margin during urological cancer surgery. The decision to reconstruct or graft the IVC depends on the location of the defect and the nature and degree of IVC obstruction. We evaluated the clinical outcomes in patients undergoing circumferential IVC resection for malignancy during the last 5 years.
Methods:Ten patients were evaluated for circumferential IVC resection. The indications for resection were recurrent renal cancer following prior IVC tumor thrombectomy(3), renal tumor thrombus extensively invading IVC wall(3), renal tumor thrombus in an IVC filter (1), Leimyosarcoma of the IVC (2) and recurrent adrenal cancer (1). All patients charts were reviewed for operative findings, complications, tumor recurrence and functional outcomes
Results:
The following resection/reconstructions were performed #1: Suprahepatic IVC with reimplantaion of hepatic veins into a graft(1) #2 Resection of the infrahepatic and perirenal IVC with graft(2) #3 Resection of the infrahepatic and perirenal IVC without graft(4) #4: Resection of infrarenal IVC with graft(1) #5: Unresectable because of extensive local disease(2). In general graft reconstruction was not performed in patients with complete occlusion of the IVC. All grafts were patent by U/S at 1 month. No patient had a pulmonary embolus. Three patients developed acute renal failure one with renal vein reconstruction (transient), one in whom the left renal vein was ligated (transient) and one who was unresectable (permenant). None of the patients developed lower extremity odema. Three patients have developed recurrent tumor to date (at 2,7,26 months) with a mean follow up for the entire group of 12months (Range 1-26).
Conclusions:
Complete resection of the IVC for malignancy can be safely performed in selected patients with reasonable disease free survival. The decision to graft the IVC should be based on preoperative symptoms and the degree of venous obstruction. The most common complication is renal failure, which is generally reversible.

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