Clinical Application Of Hybrid Surgery In Abdominal Tumor With Inferior Vena Cava Tumor Thrombus

Objective: To explore the safety and effectiveness of hybrid surgery in the treatment of abdominal tumor with inferior vena cava tumor thrombus under the multi-disciplinary treatment mode.Methods: Retrospective analysis of the clinical data of 32 patients with abdominal tumor and inferior vena cava tumor thrombosis admitted to the First Affiliated Hospital of Anhui Medical University from January 2016 to December 2021,and all patients were treated with hybrid surgery according to the type of primary tumor and the type of tumor thrombus under the multi-disciplinary treatment mode.The clinical data of patients were analyzed,such as the type of primary tumor,the type of tumor thrombus,the time of operation,the amount of intraoperative bleeding,the rate of conversion to ICU,inpatient length of stay,the incidence of complications and the survival rate.Results: The diameter of abdominal tumors: 17 cases were 10 cm or less,15 cases were more than 10 cm;the length of the tumor thrombus in the inferior vena cava: 19 cases were less than 5 cm,9 cases were 5～8 cm,and 4 cases were 8 cm and above;postoperative pathological results: 7 liver tumors,9 renal tumors,13 adrenal tumors,3 primary retroperitoneal tumors;the tumor thrombus can be divided into four types,according to the position relationship between the head of the tumor thrombus and the opening of the renal vein,the opening of the short hepatic vein or the right atrium: 4 cases of type I,9cases of type II,12 cases of type III,and 7 cases of type IV.15 patients(46.9%)underwent preoperative transcatheter arterial embolization,resulting in tumor reduction and formation of false capsule in 11 patients(73.3%).The tumor and tumor thrombus of all patients were completely removed.Tumor resection,inferior vena cava occlusion and inferior vena cava thrombectomy were performed in 17 patients.Three patients were treated with tumor resection,first hepatic portal control,inferior vena cava occlusion,and inferior vena cava thrombectomy.Six patients underwent tumor resection,total hepatic vascular exclusion,inferior vena cava occlusion,and inferior vena cava thrombectomy.Six patients with type IV tumor thrombus underwent tumor resection,total hepatic vascular exclusion,cardiopulmonary bypass,and thrombectomy via inferior vena cava(or right atrium)incision.32 cases of abdominal tumor with inferior vena cava tumor thrombus were treated by hybrid surgery under the multi-disciplinary treatment mode.The operation time was 200～630(379.9 ± 126.3)min,the intraoperative blood loss was100～4000(959.4 ± 1034.1)ml,27 patients(84.4%)were given blood transfusion,18patients(56.3%)were transferred to ICU after operation,and the inpatient length of stay was 11～45(21.4 ± 7.2)days.Postoperative complications occurred in 4 cases,with a complication rate of 12.5%,which were cured or relieved through follow-up treatment.One case died in the 30-day perioperative period,with a perioperative mortality of 3.1%.The 1-year survival rate was 81.3%,the 2-year survival rate was 63.4%,and the 3-year survival rate was 29.4%.As of September 30,2022,9 patients were still alive.The followup time of living patients was 13-64(24.1 ± 15.5)months,with a median follow-up time of 19 months.3 patients had tumor metastasis and 6 patients had disease-free survival.Twenty-three patients died.The survival time of the dead patients was 1 to 67(25.7 ±17.7)months,with a median survival time of 26 months.2 patients died of pulmonary embolism,4 patients died of cerebrovascular disease,3 patients died of myocardial infarction,and 14 patients died of tumor metastasis.Conclusion: It is an accurate,safe and effective treatment to perform hybrid surgery for patients with abdominal tumor and inferior vena cava tumor thrombosis under the multidisciplinary treatment mode.1 Integrating various professional knowledge and technologies for comprehensive treatment under the multi-disciplinary treatment mode can effectively play the advantages of various disciplines and make patients receive more accurate treatment.2 Preoperative transcatheter arterial embolization and intraoperative and postoperative transesophageal echocardiography are necessary treatment measures.3 Under the multi-disciplinary treatment mode,hybrid surgery is safe and effective in the treatment of abdominal tumors with inferior vena cava tumor thrombus,and the curative effect is significantly better than other treatment methods.