Surgeon Non-concordance on Tributary Vein Interventions is Present

Results: The median age was 55 years (IQR, 42-64.5 years).Six patients were female (85.7%).Five patients (71.4%) were non-White, and two patients (28.6%) were Hispanic or Latino.The primary diagnosis was retroperitoneal sarcoma in six patients (85.7%), and renal cell carcinoma in one patient (14.3%).Three patients (42.9%) underwent R0 resections, three patients (42.9%) underwent R1 resections, and one patient had an unresectable mass.The IVC was repaired primarily in two patients (28.6%) and was repaired using a bovine patch in three patients (42.9%).In one patient, the IVC was resected en bloc with the tumor.No reconstruction was performed due to the prolonged operative duration.However, an interposition with a PTFE graft was performed between the distal segment of the right renal vein (RRV) and the retro-hepatic IVC to save the only remaining kidney (Fig) .This patient had no significant leg swelling and continued to maintain normal kidney function.Concomitant primary repair of abdominal aorta was required in one patient.Moreover, arterial interposition with a cadaveric graft between the right common iliac artery and right external iliac artery was necessary in one patient (Table ).No 30-day mortality was observed.Intra-abdominal fluid collection was seen in two patients (28.6%) and was managed by percutaneous drainage and antibiotics.The median postoperative length of stay was 13 days (IQR, 12-17 days).Conclusions: Proper techniques in venous resection, repair, and reconstruction are essential for achieving a safe R0/R1 resection of certain intraabdominal tumors.Adequate primary repair, patch repair, or graft placement are recommended to optimize outcomes and minimize potential morbidities.Technique selection depends on amount of vein resected, baseline lower extremity and pelvic venous drainage, and need for ligation of collaterals during the case.However, in patients with significant collaterals, resection without reconstruction might be acceptable with no significant postoperative morbidities.