Surgical treatment for right upper quadrant tumors with inferior vena cava involvement
10.3877/cma.j.issn.2095-3232.2014.03.008
- VernacularTitle:累及下腔静脉的右上腹肿瘤患者的外科治疗
- Author:
Liushun FENG
1
;
Tianlang XUE
;
Jie LI
Author Information
1. 450052,郑州大学第一附属医院肝胆胰外科
- Keywords:
Vena cava,inferior;
Kidney neoplasms;
Adrenal gland neoplasms;
Retroperitoneal neoplasms;
Neoplastic cells,circulating;
Surgical procedures
- From:
Chinese Journal of Hepatic Surgery（Electronic Edition）
2014;(3):161-164
- CountryChina
- Language:Chinese
-
Abstract:
Objective To assess the safety and effects of surgical treatment for the right upper quadrant tumors with inferior vena cava involvement. Methods Clinical data of 77 patients with right upper quadrant tumors in Department of Hepatobiliary and Pancreatic Surgery, the First Afifliated Hospital of Zhengzhou University from January 2006 to December 2012 were analyzed retrospectively. There were 36 males and 41 females with age ranging from 22 to 71 years old and a median age of 51 years old. The patients included 20 cases of right renal carcinoma, 2 cases of hamartoma of right kidney, 30 cases of right adrenal tumors, 25 cases of retroperitoneal tumors. Inferior vena cava involvement was observed in 55 cases, in which 25 cases were combined with tumor thrombus of inferior vena cava. Four cases were tumor thrombus typeⅠ, 2 cases were typeⅡ, 17 cases were typeⅢ, and 2 cases were typeⅣ. The informed consents of all patients were obtained and the ethical committee approval was received. Subcostal incisions in the right upper abdomen or thoracoabdominal incisions were made and the tumors and inferior vena cava were separated and exposed. The blood lfows of inferior vena cava, renal veins and the ifrst porta were excluded depending on circumstances during the operation. For tumor thrombus typeⅠandⅡ, it was removed at the same time as the tumors were resected. For tumor thrombus typeⅢandⅣ, it was removed after the tumors were resected under cardiopulmonary bypass. The perioperative situations of patients including duration of inferior vena cava blood exclusion, intraoperative blood loss, operation duration, postoperative hospital stay, death and complications were observed. Results All the 77 cases underwent tumor resection and removal of tumor thrombus of inferior vena cava successfully. The median of duration of inferior vena cava blood exclusion was 20 (13-28)min. The intraoperative blood loss was 800(200-1 800)ml. The operation duration was 156 (120-180)min. The postoperative hospital stay was 15(10-18)d. One case died of asphyxia during the perioperative period. No other severe complication was observed during the perioperative period. Ten cases died of tumor recurrence and metastasis during the follow up. Conclusion For the patients with right upper quadrant tumors with inferior vena cava involvement, resecting the tumor and tumor thrombus is safe and effective by choosing a proper surgical approach.
