Application of segmental excision of inferior vena cava and/or external iliac vein without vascular reconstruction in complex surgeries for abdominal and pelvic tumors

Objective To summarize the experience of segmental excision of the inferior vena cava and/or external iliac vein without vascular reconstruction in complex surgeries for abdominal and pelvic tumors. Methods Clinical data of 11 patients undergoing complex surgeries for abdominal and pelvic tumors and segmental excision of the inferior vena cava and/or external iliac vein without vascular reconstruction were retrospectively analyzed. Results Among 11 cases, 3 patients developed postoperative metastases of colorectal cancer, 2 cases of renal pelvic cancer complicated with tumor thrombus and lymph node metastases, 1 case of renal pelvic cancer complicated with lymph node metastasis, 1 case of ureteral cancer complicated with lymph node metastasis, 1 case of abdominal implantation after surgery for renal pelvic cancer, 1 case of postoperative metastasis of cervical cancer, 1 case of retroperitoneal leiomyosarcoma and 1 case of bladder cancer. The surgeries involving blood vessels were performed including 5 cases of segmental resection of the inferior vena cava, 1 case of segmental resection of the right external iliac vein + segmental resection of the internal iliac artery and vein, 1 case of segmental resection of the right internal iliac artery and vein + segmental resection of the left external iliac vein, 1 case of segmental resection of the inferior vena cava + segmental resection of bilateral common iliac veins + prosthetic vessel bypass between the right common iliac artery and external iliac artery, 1 case of segmental resection of the inferior vena cava + segmental resection of the right external iliac artery and vein + prosthetic vessel replacement of the right external iliac artery and 2 cases of segmental resection of the external iliac vein, respectively. All patients successfully completed the surgeries. The median operation time was 570 （390 ~ 900） min. The median volume of intraoperative red blood cell infusion was 4 （2 ~ 15） units. The median volume of plasma transfusion was 600 （150 ~ 1800） ml. The median length of postoperative ICU stay was 0 （0 ~ 517） h. Postoperatively, venous embolism occurred in 5 cases. After conservative treatment, edema was gradually mitigated in 4 patients and international thrombolysis was delivered in 1 case. Conclusions For complex abdominal and pelvic tumors, such as tumor encasement, invasion or adhesion and of the inferior vena cava and external iliac vein, segmental resection of the involved major vein combined with ligation without vascular reconstruction can be considered. Although there is a risk of venous embolism of the lower limbs after surgery, it seldom causes severe adverse events.