gms | German Medical Science

Tumor lesions of the inferior V. cava can originate from the vein or can develop by tumor infiltration from the surrounding tissue. Tumor lesions with cones within the inferior V. cava reaching the right atrium should be of particular attention. The today´s development status and advances in surgical tactic allow the successful approach of such tumor manifestation. A deciding prediction is the abdomino-, cardio- and vasculosurgical expertise of the surgeons.

The aim of this representative case series of a surgical center through a 5-year time period after team formation of specialists was to analyze the perioperative management, the individual-specific and adapted surgical technique and the outcome including prognostic considerations.

Results: Six leiomyosarcomas of the inferior V. cava, 2 retroperitoneal tumor lesions (metastasis of a seminoma, n=1; paraganglioma, n=1), infiltrating tumor lesions from the surrounding tissue and 1 liver tumor with adhesions to the inferior V. cava were surgically approached. Tumor lesions with cones within the inferior V. cava were successfully resected w/ and w/o additional resection of the inferior V. cava in 4 renal cell carcinomas and 1 carcinoma of the pararenal gland. Spectrum of surgical techniques was as follows: i) Complete resection and substitution of the inferior V. cava by a prosthesis along the previous distance of tumor growth, ii) partial resection of the wall with subsequent patch plastic, iii) tangential resection with primary suture, or iv) removal of the V. cava thrombus after cavotomy. Tumor thrombi reaching the right atrium needed to be extracted after sterno- and atriotomy using an extracorporal circulation. The surgical aim to reconstruct the streakline of the inferior V. cava was achieved in all cases. The hospital mortality was 0 %. The prognosis of the various tumor lesions was different.

Conclusion: For surgical planning, subdivision of the inferior V. cava into 4 segments has been proven and tested: Infracardiac segment, hepatic, renal and infrarenal third. The primary surgical aim is the R0 resection with reconstruction of the inferior V. cava streakline with a reasonable ratio of risk and benefit. Only then, prognostic advantages are measurable.