Surgical Resection of Abdominal Solid Organ Tumors With Inferior Vena Cava Extension: A Single-Center Experience With Long-Term Follow-Up

TL;DR

This study examines long-term survival and outcomes of complex surgeries for abdominal tumors extending into the inferior vena cava.

Contribution

The study provides a single-center long-term follow-up on high-risk surgeries for abdominal tumors with vena cava extension.

Findings

Radical resection using cardiopulmonary bypass is feasible with acceptable long-term survival.

In-hospital mortality was 10.3% despite complex procedures and multidisciplinary care.

Estimated 10-year overall survival was 46.1% with a mean follow-up of 4.8 years.

Abstract

Introduction: Abdominal solid organ malignancies, particularly renal and adrenal tumors, may extend into the inferior vena cava (IVC) as tumor thrombus and, in rare cases, reach the right atrium. Surgical management is technically demanding and associated with significant perioperative risk. This study evaluates perioperative outcomes and long-term survival after radical resection of abdominal tumors with IVC extension using cardiopulmonary bypass (CPB).

Materials and methods: A prospectively maintained dataset was retrospectively analyzed for adult patients who underwent surgical management of abdominal solid organ tumors with IVC extension between June 2002 and September 2023 at a tertiary referral center. Procedures were performed by a multidisciplinary team. CPB was used in all cases. The extent of venous involvement was categorized using the Mayo Clinic classification system. The primary outcome was long-term survival, and secondary outcomes included perioperative complications and in-hospital mortality.

Results: Thirty-nine patients underwent resection (mean age 61 ± 11.3 years; 74.3% male). Tumors originated most commonly from the kidney (87.1%), followed by the adrenal gland (10.3%), with one case of primary IVC intimal sarcoma. Clear cell RCC was the predominant histological subtype. Mean operative duration was 390 minutes; mean CPB time was 145 minutes; mean ischemia time was 55 minutes; and mean hypothermic circulatory arrest (HCA) time was 33 minutes. In-hospital mortality was 10.3%, including two intraoperative deaths. Mean follow-up was 4.8 ± 3.5 years. Estimated overall survival at 1, 5, and 10 years was 87.1%, 64.1%, and 46.1%, respectively.

Conclusions: Radical resection of abdominal solid organ tumors with IVC extension using CPB is feasible and can provide acceptable long-term survival despite substantial perioperative risk. A multidisciplinary approach is essential to optimize outcomes in these complex cases.

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