Systematic Review of Surgical Management of Nonmetastatic XXXX with Vena Caval Thrombus.

@entity1 @entity8 @entity5 @entity1358 @entity703
CONTEXT: Overall, 4-10% of @entity1 with @entity1358 ( @entity1358 ) present with @entity5 thrombus. It is uncertain which surgical technique is best for these @entity1 . Appraisal of outcomes with differing techniques would guide practice. OBJECTIVE: To systematically review relevant literature comparing the outcomes of different surgical therapies and approaches in treating vena caval thrombus (VCT) from nonmetastatic @entity1358 . EVIDENCE ACQUISITION: Relevant databases (Medline, Embase, and the Cochrane Library) were searched to identify relevant comparative studies. Risk of bias and confounding assessments were performed. A narrative synthesis of the evidence was presented. EVIDENCE SYNTHESIS: The literature search identified 824 articles. Fourteen studies reporting on 2262 @entity1 were included. No distinct surgical method was superior for the excision of VCT, although the method appeared to be dependent on @entity5 thrombus level. Minimal access techniques appeared to have better perioperative and recovery outcomes than traditional median sternotomy, but the impact on oncologic outcomes is unknown. @entity8 did not offer any oncologic benefits and instead resulted in significantly worse perioperative and recovery outcomes, including possibly higher perioperative mortality. The comparison of cardiopulmonary bypass versus no cardiopulmonary bypass showed no differences in oncologic outcomes. Overall, there were high risks of bias and confounding. CONCLUSIONS: The evidence base, although derived from retrospective case series and complemented by expert opinion, suggests that @entity1 with nonmetastatic @entity1358 and VCT and acceptable performance status should be considered for surgical intervention. Despite a robust review, the findings were associated with uncertainty due to the poor quality of primary studies available. The most efficacious surgical technique remains unclear. @entity1 SUMMARY: We examined the literature on the benefits of @entity703 that have spread to neighbouring veins. The results suggest such surgery, although challenging and associated with high risk of complications, appears to be feasible and effective and should be contemplated for suitable @entity1 if possible; however, many uncertainties remain due to the poor quality of the data.
