A Cut Above? Retrospective review of a dual-centre experience – inferior vena cava resection in renal and adrenal cancer surgery of curative intention.
BAUS ePoster online library. Tang S. 06/25/19; 259577; P8-12
Sarah Tang
Sarah Tang
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Abstract
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INTRODUCTION

Intracaval extension presents a surgical challenge when renal and adrenal tumours are resected. Tumours may be adherent to the caval wall which may thus need to be resected. Resection of the involved segment without synthetic graft reconstruction has been described without prohibitive long term morbidity.

Patients and Methods
Prospectively collected BAUS Data and Audit System records were obtained for two operating surgeons, at two specialist Urological Cancer centres. We also retrospectively reviewed case notes of patients with intracaval extensions of renal and adrenal tumours who underwent inferior vena cava (IVC) resection without reconstruction, assessing operative parameters, length of stay, complications and follow-up status.

RESULTS

Twenty-eight patients underwent IVC resection without reconstruction between May 2013 and February 2017. No perioperative or early deaths occurred. Fourteen patients had complications: sepsis, pneumonia, congestive cardiac failure, acute kidney injury, symptomatic peripheral deep venous thrombosis, splenectomy, and chylous leak. Lower limb oedema was uncommon but invariably transient. To date, six patients have died and two progressed to metastatic disease, giving a 71% progression-free survival.

Conclusions
This case series illustrates our experience of IVC resection without reconstruction as an acceptably safe procedure. This should be considered as an alternative to the more widely advocated approach of graft replacement in this clinical scenario.
INTRODUCTION

Intracaval extension presents a surgical challenge when renal and adrenal tumours are resected. Tumours may be adherent to the caval wall which may thus need to be resected. Resection of the involved segment without synthetic graft reconstruction has been described without prohibitive long term morbidity.

Patients and Methods
Prospectively collected BAUS Data and Audit System records were obtained for two operating surgeons, at two specialist Urological Cancer centres. We also retrospectively reviewed case notes of patients with intracaval extensions of renal and adrenal tumours who underwent inferior vena cava (IVC) resection without reconstruction, assessing operative parameters, length of stay, complications and follow-up status.

RESULTS

Twenty-eight patients underwent IVC resection without reconstruction between May 2013 and February 2017. No perioperative or early deaths occurred. Fourteen patients had complications: sepsis, pneumonia, congestive cardiac failure, acute kidney injury, symptomatic peripheral deep venous thrombosis, splenectomy, and chylous leak. Lower limb oedema was uncommon but invariably transient. To date, six patients have died and two progressed to metastatic disease, giving a 71% progression-free survival.

Conclusions
This case series illustrates our experience of IVC resection without reconstruction as an acceptably safe procedure. This should be considered as an alternative to the more widely advocated approach of graft replacement in this clinical scenario.
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