Inferior vena cava resection and reconstruction with bovine pericardium for renal cell carcinoma: complications and outcomes

Abstract Objectives To assess the post-operative complication rate and overall survival when bovine pericardium is used as graft material for inferior vena cava reconstructions in patients with renal cell carcinoma. The ideal graft material is yet to be established, with synthetic grafts widely studied and used in the current literature. Methods We performed a retrospective cohort analysis of consecutive patients who underwent inferior vena cava reconstructions as part of resection for renal cell carcinoma, using bovine pericardium as either a patch repair or tubular interposition graft. Results A total of 15 patients underwent resection with inferior vena cava reconstruction between 2010 and 2018. Nine patients had tubular interposition grafts and six had patch repairs. Three patients had Clavien-Dindo grade 3 or higher short-term complications. There was no difference in Comprehensive Complications Index between those who had interposition grafts and patch repairs. Two patients had a long-term graft-associated thrombus requiring temporary anticoagulation. Overall survival was 46.5 months (95% CI 36.9–56.1). There were no perioperative deaths. All long-term deaths were due to disease progression. Conclusions Reconstruction of the inferior vena cava with a bovine pericardium graft is safe in experienced centres. Bovine pericardium could be considered as the material of choice given its safety in the immediate post-operative period, ease of use, and patency without routine long-term anticoagulation. Advanced surgical management leads to good overall survival in this cohort with high tumour burden.