Management of Renal Cell Carcinoma With Level III Thrombus in the Inferior Vena Cava

Ciancio, Gaetano; Vaidya, Anil; Savoie, Mark; Soloway, Mark S.

doi:10.1097/00005392-200210010-00016

Cited by 61 publications

(102 citation statements)

References 18 publications

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“…classified as those extending Յ2 cm above the renal vein, level II as extending Ͼ2 cm above renal vein but remaining infrahepatic, level III as retrohepatic, and level IV as extending above the diaphragm into the right atrium. To aid in determining the extent of vascular isolation required for a given tumor, our group has further refined this system to include subcategories for level III tumors [7]. In this modified classification system, level IIIa tumors are defined as those with thrombus extending into the retrohepatic IVC but ending below the origins of the major hepatic veins, level IIIb as extending to the ostia of the major hepatic veins, level IIIc as extending above the major hepatic veins but below the diaphragm, and level IIId as extending above the diaphragm but not into the right heart ( Fig.…”

Section: Preoperative Planningmentioning

confidence: 99%

Transplantation techniques for the resection of renal cell carcinoma with tumor thrombus: A technical description and review

Gorin

González

Garcia-Roig

et al. 2013

Urologic Oncology: Seminars and Original Investigations

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Section: Preoperative Planningmentioning

confidence: 99%

Transplantation techniques for the resection of renal cell carcinoma with tumor thrombus: A technical description and review

Gorin

González

Garcia-Roig

et al. 2013

Urologic Oncology: Seminars and Original Investigations

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“…Because of the prognostic relevance of the cranial intracaval neoplastic extension and the surgical consequences related to IVC exposure as well as the degree of vascular control required to extract these thrombi,5 group III is further subdivided according to the anatomical relation of the thrombus to the major hepatic veins6:-…”

Section: Classificationmentioning

confidence: 99%

“…This group of caval thrombi poses a challenge to the surgeon due to its relative inaccessibility as the surgeon can not directly visualize the involved part of IVC 6. So, hepatic mobilization using liver transplantation (piggyback) technique is done to allow adequate exposure of the retrohepatic IVC 1.…”

Section: Surgical Principlesmentioning

confidence: 99%

Renal Cell Carcinoma with IVC Thrombi; Current Concepts and Future Perspectives

Nouh

Inui

Kakehi

2008

Clinical medicine. Oncology

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Abstract:The incidence of venous extension to the inferior vena cava (IVC) in renal cell carcinoma (RCC) is markedly increased recently mostly due to the advances in diagnostic modalities. Such vascular invasion implies a heightened biologic behavior and a surgical challenge during the course of treatment. In this study, we reviewed the classifi cation guidelines, recent diagnostic tools and up-to-date therapeutic modalities for RCC with IVC tumor thrombi added to the prognostic signifi cance regarding the pathologic nature of vascular invasion; cephalad extent of thrombi and any associated distant metastasis. Also, we are providing our suggestion regarding the use of angioscopy for removal of IVC thrombi in a relatively bloodless fi eld without aggressive surgical manipulations or shunt techniques for maintenance of hemodynamic stability.

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“…In the case of a Stage 3c tumor, which extends above the diaphragm, the surgeon then "milks down" the thrombus to below the level of the hepatic veins. The proximal tourniquet is then placed below the hepatic veins (13). TEE can also play a crucial role in monitoring the progress of the tumor being "milked down" and helps to confirm the absence of residual tumor (1,14).…”

Section: Discussionmentioning

confidence: 99%

The Role of Transesophageal Echocardiography in Rapid Diagnosis and Treatment of Migratory Tumor Embolus

Chen¹,

Ng²,

Kane³

et al. 2004

Anesthesia & Analgesia

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Transesophageal echocardiography (TEE) is sometimes used in renal cell carcinoma excision for evaluating the extension of tumor in the inferior vena cava (IVC), characterizing the tumor anatomy, monitoring the tumor during surgical mobilization, and assessing cardiac function. Although the risk for embolization is small, when embolization does occur, its consequences can be catastrophic. In this case report, we describe the crucial role of TEE in diagnosing an intraoperative migratory embolus from the IVC to the pulmonary artery and also provide both single-frame photographs and Internet-accessible videos of the event. Our case illustrates the key role that TEE played in the intraoperative management of a patient with renal cell carcinoma undergoing surgical excision of tumor. TEE aided in accurately defining the cephalad extent of the thrombus, provided continuous monitoring of the thrombus during surgical manipulation, and allowed immediate identification of its embolization and proper notification of the surgeons. This case illustrates the crucial role TEE played in the management of a migratory tumor embolus and argues for its routine use during excision of renal cell carcinomas invading the IVC.

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Management of Renal Cell Carcinoma With Level III Thrombus in the Inferior Vena Cava

Cited by 61 publications

References 18 publications

Transplantation techniques for the resection of renal cell carcinoma with tumor thrombus: A technical description and review

Transplantation techniques for the resection of renal cell carcinoma with tumor thrombus: A technical description and review

Renal Cell Carcinoma with IVC Thrombi; Current Concepts and Future Perspectives

The Role of Transesophageal Echocardiography in Rapid Diagnosis and Treatment of Migratory Tumor Embolus

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