MP79-05 RESECTION OF THE INFERIOR VENA CAVA WITHOUT GRAFTING IN ADVANCED UROLOGIC MALIGNANCY

INTRODUCTION AND OBJECTIVES: Several advanced urologic malignancies can present with focal invasion of the inferior vena cava (IVC). When segmental resection of the IVC is oncologically necessary the need for caval reconstruction remains controversial. We reviewed our institution’s contemporary experience with the management of caval resection in patients presenting with advanced urologic malignancy to evaluate perioperative outcomes and whether pre-operative predictors of extensive caval involvement exist. METHODS: We queried our IRB approved genitourinary cancer databases for any case that included resection of the vena cava. Indications for resection included encasement or invasion of the cava, thrombus in which cavotomy and thrombectomy could not be performed, and postchemotherapy desmoplastic compression. Pre-operative predictors of caval involvement and the long-term morbidity of IVC resection were assessed. RESULTS: Between September 2010 and October 2014, 22 patients (median age of 47) underwent successful surgical extirpation of urologic cancers with resection of the inferior vena cava due to invasion. Pathology revealed renal cell carcinoma (9), upper tract urothelial cancer (6), testis cancer (6), and malignancy of adrenal origin (2). These included 13 infrarenal and 9 suprarenal resection of the IVC; one patient with suprarenal IVC resection underwent reconstruction with a PTFE graft. 21 of 22 patients were alive with mean post-operative follow-up of 9.1 months (1-45 m). Pre-operatively 6 patients (27%) had radiologic evidence of IVC involvement and 3 (14%) patients presented with lower extremity edema. Mean operative time was 491 minutes (302 e 754 min). Mean estimated blood loss was 3.84L (0.3-18L) and transfusion requirement was mean of 12.6 units (0-49 units). Mean length of hospital stay was 8.8 days (4-29 days). Six patients (27%) had pathologically confirmed IVC wall invasion. Postoperatively 5 patients (23%) developed deep venous thrombosis and 8 patients (36%) had lower extremity edema at time of discharge. At the time of the most recent follow-up this edema had resolved in all but 1 patient. All patients were successfully treated for DVT with no long-term sequelae. CONCLUSIONS: IVC resection without reconstruction is a welltolerated procedure with minimal sequelae following complete caval resection. Caval resection without reconstruction obviates the need for grafts and potential thrombosis. A significant number of patients did have identifiable evidence of caval involvement on pre-operative imaging which may serve as a predictor for caval resection.