Modified IVC Clamping Technique in the Left Radical Nephrectomy and Mayo II-III IVC Thrombectomy: A Preliminary Experience

Abstract

Background: To present our initial experiences on the left radical nephrectomy (RN) and Mayo II-III IVC thrombectomy (IVCTE) using modified inferior vena cava (IVC) clamping technique. Methods: From November 2016 to July 2018, eight left renal cell carcinoma (RCC) patients with inferior vena cava tumor thrombus (IVCTT) underwent retroperitoneal laparoscopic RN and IVCTE using the modified IVC clamping technique. During the IVCTE, the infrarenal IVC, right renal artery, right renal vein were clamped sequentially, then the cephalic IVC of the tumor thrombus was clamped immediately after the thrombus was removed.Results: According to the preoperative plans, all 8 operations were completed successfully without perioperative mortality. Median operative time was 438 min (343-573 min). Median IVC blocking time was 18 min (12-28min), and median warm ischemia time (WIT) for the right kidney was 19min (14-28min). Median estimated intraoperative blood loss was 1107mL (50-6000 ml). Some 50% of patients required an intraoperative blood transfusion. Median length of hospital stay was 12.9 days (6-39). Early postoperative complications occurred in 2 cases, 1 was Clavien class II, another was Clavien class IVa. All 8 patients were followed up continually with a median follow-up period of 16 months (5-25 months). During the mean follow-up period, three patients developed metastatic disease.Conclusions: Modified IVC clamping technique, which is feasible and safe for experienced surgeons in selected patients, can simplify the procedures left RN and Mayo II-III IVCTE.