Surgery for retrohepatic caval thrombus in patients with advanced renal cell carcinoma: a case series

Abstract

BackgroundThrombotic involvement of the inferior vena cava (IVC) occurs in about 10 % of all patients with renal cell carcinoma (RCC). It is treated with radical resection of tumor and thrombus. We present the results of a recent case series of 20 patients with retrohepatic IVC thrombus.MethodsOur cohort of 20 patients included 16 primary resections (radical nephrectomy and thrombectomy with and without vascular graft), three recurrences primarily operated on elsewhere (thrombectomy and vascular graft), and one recurrence due to a new liver metastasis.ResultsAll surviving patients were discharged with a patent IVC. The overall mortality rate was 10 %, and the overall complication rate was 35 %. Both are in keeping with results presented worldwide.ConclusionsOur series provides a corroborating extension to the existing dataset on RCC-related IVC thrombus removal. It confirms that the radical surgical approach can be performed safely and successfully with respect to venous patency.

Xeno‐pericardial patch repair of the inferior vena cava for radical resection of renal cell carcinoma with tumor thrombus

“…Novick classification IV, in which the tumor was present in the right atrium, is the surgical challenge even in the contemporary reported series . It was reported that circulatory arrest under deep hypothermia is an option for the Novick IV to expose a blood‐free surgical view of the IVC .…”

“…Novick classification IV, in which the tumor was present in the right atrium, is the surgical challenge even in the contemporary reported series. 3,13 It was reported that circulatory arrest under deep hypothermia is an option for the Novick IV to expose a blood-free surgical view of the IVC. 16 However, in the present series, extracorporeal circulation with heart beating provided an almost blood-free view of the IVC by adding incision of the diaphragm and liver ischemia.…”

“…Surgical resection of renal cell carcinoma complicated by tumor thrombus in the inferior vena cava (IVC) is one of the challenges with reported mortality being 2.7‐10% even in the contemporary series, although it reportedly contributes to improvement of symptom and prognosis in more than half of the affected patients . Keys of surgical success would include (1) complete removal of the malignant tissue by en bloc tumor resection; (2) re‐establishment of the venous return by adequate IVC repair; and (3) minimum surgery‐associated organ damages .…”

Tumor Obstruction of the Inferior Vena Cava and Its Tributaries: Diagnosis, Features of Surgical Interventions, the Results of Surgical Treatment. Part I

“…По данным различных авторов [11,12,15,16,20], инвазия стенки НПВ при опухолевых тромбах при ПКР отмечается у 10-30 % больных. Вариантами хирургической тактики в этой ситуации являются резекция НПВ без восстановления просвета, резекция НПВ и замещение дефекта заплатой, резекция НПВ и протезирование синтетическим протезом.…”

“…В литературе последних лет все чаще упоминаются наблюдения успешного лечения распространенного рака почки с отдаленными метастазами и с опухолевым тромбозом почечной и нижней полой вен [4,7,11,14,15]. Это направление исследований тем более актуально с учетом того, что доля таких больных, по данным отдельных авторов [3], может достигать до 70 % от общего числа пациентов.…”