Early and late outcomes of patients treated with graft replacement of the inferior vena cava for malignant disease: A single-center experience over three decades.

OBJECTIVE

To describe early and late outcomes of segmental resection and graft replacement of the inferior vena cava (IVC) for malignant disease over three decades.

METHODS

All patients who had IVC resection with graft replacement from 1990 to 2024 at a single institution were retrospectively reviewed. Patients with tangential excision and primary or patch venorrhaphy were excluded. End points were early (<30 days) mortality, major adverse events, graft-related complications, primary patency, overall survival, and freedom from local recurrence.

RESULTS

One hundred sixty-seven patients (54% female; mean age at operation 55 ±14 years) had IVC resection and graft replacement. Primary IVC leiomyosarcoma occurred in 69 patients (41%) and other secondary malignancies in 97 (58%). Preoperative performance status (Eastern Cooperative Oncology Group) was good or excellent in 153 patients (92%). Resection of multiple IVC segments was required in 94 patients (56%), 41 who needed renal vein reconstruction or implantation (25%) and 6 (3.6%) who had hepatic vein implantation. Graft replacement was with ringed polytetrafluoroethylene in 163 patients (98%). Two patients died of intraoperative hemorrhage. Six others died within 4 months; three were procedure-related. One or more major adverse events occurred in 28 patients (17%). Intra-abdominal hemorrhage requiring transfusion was the most common complication, occurring in 10 patients (5.9%). Only one patient developed permanent renal or liver failure. Two patients (1.2%) had asymptomatic subsegmental pulmonary emboli. Over a mean follow-up of 5.5 ± 5.8 years (median 3.2 [1.2, 7.5] years), 10 patients experienced graft occlusion (5.9%). Two occlusions were within 1 month of graft placement, two were within 1 year, and 6 were over 1 year, with one at 23 years postoperatively. Four patients had stents placed to treat asymptomatic high-grade stenoses, one early and three late. There were four graft infections, all related to small bowel leaks. The median overall survival was 52% and 36% at 5 and 10 years, respectively (range, 0-27 years). Freedom from local recurrence was 85%, 71%, and 54% at 1, 5, and 10 years, respectively. Kaplan-Meier estimates of IVC graft primary patency were 96%, 95%, and 88% at 1, 5, and 10 years, respectively.

CONCLUSIONS

IVC resection and graft replacement for malignant disease are safe and durable, and provide excellent local control of the tumor, offering a chance for long-term survival in select patients.