2000 Volume 11 Issue 4 Pages 295-301
The significance of combined resection of inferior vena cava (IVC) in surgery for liver cancer and renal cell carcinoma (RCC) was studied. Eleven patients with liver cancer involving IVC (tumor thrombus, one patient ; difect invasion, 10), 7 patients with RCC (tumor thrombus), and one patient with adrenal cortical carcinoma (tumor thrombus) participated in this study. Macroscopic curative resection was obtained in 18 of 19 patients. The type of IVC reconstruction was simple closure in 13 cases, patch-graft repair in 1, and prosthetic graft replacement in 5. No postoperative complications associated with the IVC reconstruction occurred. However, the carcinoma recurred in all patients of liver cancer 9.2 months after operation in mean (in 90% of the patients the recurrence was in the remnant liver), and recurred in 5 of 8 patients of RCC or adrenal cortical carcinoma 12.3 months after operation (in 80% of them the recurrence was in the lung). The 1-, 3- and 5-year survival rate of the patients of RCC was 100%, 43%, and 43% respectively, while the 1- and 3-year survival rate of the patients of liver cancer was 64% and 13%. Mean hospital-free ratio was 76% in the patients of RCC and 48% in the patients of liver cancer. These results indicated the poor long-term outcome after surgery in the patients of liver cancer. The aggressive resection taken here for the malignancies involving vena cava could improve quality of life (QOL) in short-term after surgery, however could not obtain the sufficient long-term survival and QOL in the patients of liver cancer. Therefore, the indication of surgical resection for patients with liver cancer should be considered cautiously.
