Trends and Outcomes of Surgical Reconstruction of the IVC after Oncologic Resection.

Abstract

En bloc resection with IVC reconstruction is often required for retroperitoneal and solid organ tumors involving the IVC. Techniques include direct repair, patch angioplasty, and interposition grafting. We conducted a retrospective review of all patients who underwent IVC reconstruction between January 2013 and June 2023 at a single tertiary center. Outcomes included reconstruction type, long-term patency, and survival. Eighty patients (mean age 59 ± 15.9 years; 63.8% men) underwent IVC reconstruction: direct repair (38.8%), patch angioplasty (48.8%), and interposition graft (12.4%). Renal cell carcinoma (56.3%) and retroperitoneal sarcomas were the most common tumor types. Most tumors were high grade (53.8%), with IVC involvement most frequently at the perirenal level (63.8%). Antithrombotic regimens at discharge included aspirin (47.5%) and systemic anticoagulation (50%). Complete or severe thrombosis occurred in 12.5% of patients, largely due to local recurrence (50%) or early technical issues (40%). Kaplan-Meier estimated primary patency at 1, 2, and 3 years was 97.6%, 94.4%, and 87.7%, respectively. Thirty-day survival was 96.3%, with 1-, 2-, and 3-year survival rates of 86.5%, 76.8%, and 76.8%, respectively. IVC reconstruction during oncologic resection is safe and durable, with high mid-term patency and survival when performed at high-volume centers. Thrombosis is uncommon and often attributable to tumor recurrence or technical factors.