Inferior vena cava thrombectomy for renal cell carcinoma: perioperative systemic therapy, cytoreductive nephrectomy, and complex cases

Ray, Shagnik; Singer, Eric A.; Dason, Shawn

doi:10.21037/atm-23-1073

Cited by 3 publications

(4 citation statements)

References 25 publications

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“…Although there are several articles demonstrating that an abdominal approach to the supradiaphragmatic vena cava is feasible, there are several important drawbacks to this approach (such as the need for Pringle maneuver on the hepatic pedicle, possible damage to the posterior wall of the inferior vena cava, uncontrolled bleeding), patients with a friable thrombus tip may be at risk of intraoperative embolization. 9 , 11 , 12 Although the complications of a CBP bypass are not neglectable, we consider that these cases should be performed under CBP bypass with or without DHCA in order to minimize the risk of intraoperative tumor thrombus embolization.…”

Section: Discussionmentioning

confidence: 99%

“…Although modern systemic treatment with immune checkpoint inhibitors and tyrosine kinase inhibitors has considerably improved survival for metastatic RCC, the usage of these drugs in an adjuvant setting after radical treatments is controversial and is not reimbursed in most of the European countries. 1 , 12 Several trials, such as Keynote 564 (NCT03142334) or Checkmate 914 (NCT03138512), are now being conducted to evaluate these drugs in the adjuvant context for non-metastatic patients who are at high risk of recurrence, such as those with IVC tumor thrombus. 35 , 36 In our cohort, only six patients received adjuvant treatment with targeted therapy, and the impact of these treatments on the overall survival could not be assessed.…”

Section: Discussionmentioning

confidence: 99%

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Current role of intraoperative cell salvage techniques in the management of renal tumors with level III and IV inferior vena cava thrombus extension

Surcel,

Dotzauer,

Mirvald

et al. 2024

Therapeutic Advances in Urology

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Background: En bloc removal of the kidney with tumor thrombus excision in a multidisciplinary team remains the standard treatment for renal cell carcinoma (RCC) with tumor thrombus extension. In order to minimize the hemodynamic impact of the surgical blood loss, intraoperative cell salvage (IOCS) techniques can decrease the need for allogeneic blood and prevent blood transfusion related complications. Objective: In this article, we evaluated the safety of IOCS during radical nephrectomy with inferior vena cava thrombectomy under cardiopulmonary bypass with or without deep hypothermic circulatory arrest. Design and method: In this retrospective comparative multicenter analysis, clinical characteristics of 27 consecutive patients who underwent surgery with or without IOCS between 2012 and 2022 in three referral care units were collected into a database. The need for an allogenic blood transfusion (ABT) was also recorded, defined as any transfusion that occurred either intraoperatively or during the hospital stay. Results: The need for ABT in the cell saver arm was significantly smaller due to the reinfusion of rescued blood ( p < 0.015). In multivariate analysis, no cell saver usage was an independent predictor for complications ⩾3 Clavien 3a [odds ratio (OR) 18.71, 95% CI 1.056–331.703, p = 0.046]. No usage of IOCS was an independent predictor for a lower risk of death (OR 0.277, 95% CI 0.062–0.825, p = 0.024). During follow-up, patients who received salvaged blood did not experience an increased risk for developing local recurrence or distant metastases. Conclusion: Transfusion of autologous blood is safe and can be using during nephrectomy and thrombectomy for advanced RCC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Current role of intraoperative cell salvage techniques in the management of renal tumors with level III and IV inferior vena cava thrombus extension

Surcel,

Dotzauer,

Mirvald

et al. 2024

Therapeutic Advances in Urology

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“…Neoadjuvant SABR to RCC IVC-TT is also currently under investigation in an open clinical trial (NCT02473536) [64]. Margulis et al reported the viability of this strategy in the safety lead-in stage of the above phase II trial with six patients who received SABR to the IVC-TT (40 Gy in 5 fractions) followed by radical nephrectomy and thrombectomy.…”

Section: Neoadjuvant Sabr For Rcc With Ivc-ttmentioning

confidence: 99%

Incorporating Stereotactic Ablative Radiotherapy into the Multidisciplinary Management of Renal Cell Carcinoma

Raj,

Upadhyay,

Wang

et al. 2023

Current Oncology

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Stereotactic ablative radiotherapy (SABR) has challenged the conventional wisdom surrounding the radioresistance of renal cell carcinoma (RCC). In the past decade, there has been a significant accumulation of clinical data to support the safety and efficacy of SABR in RCC. Herein, we review the use of SABR across the spectrum of RCC. We performed an online search of the Pubmed database from January 1990 through April 2023. Studies of SABR/stereotactic radiosurgery targeting primary, extracranial, and intracranial metastatic RCC were included. For SABR in non-metastatic RCC, this includes its use in small renal masses, larger renal masses, and inferior vena cava tumor thrombi. In the metastatic setting, SABR can be used at diagnosis, for oligometastatic and oligoprogressive disease, and for symptomatic reasons. Notably, SABR can be used for both the primary renal tumor and metastasis-directed therapy. Management of RCC is evolving rapidly, and the role that SABR will have in this landscape is being assessed in a number of ongoing prospective clinical trials. The objective of this narrative review is to summarize the evidence corroborating the use of SABR in RCC.

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“…Inferior vena cava (IVC) tumor thrombus is found in 10% of patients undergoing nephrectomy for renal cell carcinoma (RCC) ( 1 ). The presence of an IVC tumor thrombus poses a number of important considerations during nephrectomy ( 2 ). Foremost amongst these is the potential for embolization of the tumor thrombus during the operation.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Embolization during Inferior Vena Cava Tumor Thrombectomy for Renal Cell Carcinoma

A. Roberts,

Satija,

Gold

et al. 2023

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Intraoperative tumor thrombus embolization is a potentially lethal complication during inferior vena cava (IVC) thrombectomy for renal cell carcinoma (RCC). Intraoperative embolization is uncommonly encountered because IVC thrombectomy surgical technique is focused on avoiding this complication. Nonetheless, early recognition of embolization is essential so that emergent management can be instituted. When available, cardiopulmonary bypass (CPB) and embolectomy should be considered the gold standard for the management of intraoperative embolization. Several novel endovascular techniques are also available for selective use. We present the case of a 71-year-old female with a right renal mass and level II (retrohepatic) IVC tumor thrombus. During cytoreductive nephrectomy and IVC thrombectomy, tumor embolization was diagnosed during a period of hypotension based on transesophageal echocardiographic finding of new thrombus within the right atrium. This prompted sternotomy, CPB, and pulmonary artery embolectomy. The patient survived this embolization event and has a complete response to systemic therapy 9 months postoperatively. This case serves as the framework for a discussion on management considerations surrounding intraoperative embolization during IVC thrombectomy.

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Inferior vena cava thrombectomy for renal cell carcinoma: perioperative systemic therapy, cytoreductive nephrectomy, and complex cases

Cited by 3 publications

References 25 publications

Current role of intraoperative cell salvage techniques in the management of renal tumors with level III and IV inferior vena cava thrombus extension

Current role of intraoperative cell salvage techniques in the management of renal tumors with level III and IV inferior vena cava thrombus extension

Incorporating Stereotactic Ablative Radiotherapy into the Multidisciplinary Management of Renal Cell Carcinoma

Intraoperative Embolization during Inferior Vena Cava Tumor Thrombectomy for Renal Cell Carcinoma

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