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The Journal of Cardiovascular Surgery 2022 December;63(6):664-73

DOI: 10.23736/S0021-9509.22.12408-0


lingua: Inglese

Dealing with malignancy involving the inferior vena cava in the 21st century

Marco BAIA 1, 2 , David N. NAUMANN 1, Chee S. WONG 3, Fahad MAHMOOD 1, Alessandro PARENTE 4, 5, Daniele BISSACCO 6, Max ALMOND 1, Samuel J. FORD 1, Fabio TIROTTA 1, Anant DESAI 1

1 Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Birmingham, UK; 2 Sarcoma Service, Department of Surgery, IRCCS Istituto Nazionale Tumori Foundation, Milan, Italy; 3 Department of General Surgery, Glasgow Royal Infirmary, Glasgow, UK; 4 Unit OF HPB and Transplant, Department of Surgical Science, Tor Vergata University, Rome, Italy; 5 Department of Hepatopancreatobiliary and Liver Transplant Surgery, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Birmingham, UK; 6 Unit of Vascular Surgery, IRCCS Istituto Auxologico Italiano, Milan, Italy

INTRODUCTION: Malignancies involving the inferior vena cava (IVC) have historically been considered not amendable to surgery. More recently, involvement of the IVC by neoplastic processes in the kidney, liver or in the retroperitoneum can be managed successfully.
EVIDENCE ACQUISITION: In this systematic review we summarize the current evidence regarding the surgical management of the IVC in cases of involvement in neoplastic processes. Current literature was searched, and studies selected on the base of the PRISMA guidelines. Evidence was synthesized in narrative form due to heterogeneity of studies.
EVIDENCE SYNTHESIS: Renal cell carcinoma accounts for the greatest proportion of studied patients and can be managed with partial or complete vascular exclusion of the IVC, thrombectomy and direct closure or patch repair with good oncological prognosis. Hepatic malignancies or metastases may involve the IVC, and the joint expertise of hepatobiliary and vascular surgeons has developed various strategies, according to the location of tumor and the need to perform a complete vascular exclusion above the hepatic veins. In retroperitoneal lymph node dissection, the IVC can be excised en-block to guarantee better oncological margins. Also, in retroperitoneal sarcomas not arising from the IVC a vascular substitution may be required to improve the overall survival by clearing all the neoplastic cells in the retroperitoneum. Leiomyoma can have a challenging presentation with involvement of the IVC requiring either thrombectomy, partial or complete substitution, with good oncological outcomes.
CONCLUSIONS: A multidisciplinary approach with specialist expertise is required when dealing with IVC involvement in surgical oncology. Multiple techniques and strategies are required to deliver the most efficient care and achieve the best possible overall survival. The main aim of these procedures must be the complete clearance of all neoplastic cells and achievement of a safe margin according to the perioperative treatment strategy.

KEY WORDS: Vena cava, inferior; Neoplasms; Surgical oncology; Vascular surgical procedures

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