Skip to main content

Advertisement

SpringerLink
Log in

Nephrectomy and IVC thrombectomy in renal cancer: a narrative review

  • REVIEW ARTICLE
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Renal cell carcinoma accounts for two to three percent of adult malignancies and can lead to inferior vena cava (IVC) thrombosis. This condition can decrease the rate of 5-year survival for patients to 60%. The treatment of choice in such cases is radical nephrectomy and inferior vena cava thrombectomy. This surgery is one of the most challenging due to many perioperative complications. There are many controversial methods reported in the literature. Achieving the free of tumor IVC wall and the possibility of thrombectomy in cases of level III and level IV IVC thrombosis are two essential matters previously advocated open approaches. Nevertheless, open approaches are being replaced by minimally invasive techniques despite the difficulty of the surgical management of IVC thrombectomy. This paper aims to review recent evidence about new surgical methods and a comparison of open, laparoscopic, and robotic approaches. In this review, we present the latest surgical strategies for IVC thrombectomy and compare open and minimally invasive approaches to achieve the optimal surgical technique. Due to the different anatomy of the left and right kidneys and variable extension of venous thrombosis, we investigate surgical methods for left and right kidney cancer and each level of IVC venous thrombosis separately.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Data availability is not applicable in our manuscript.

References

  1. Ma S, Jia W, Hou G, Quan P, Zhang L, Fan X, et al. Case reports of robot-assisted laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy. Medicine. 2021;100:e26886.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Velasquez MC, Mouzannar ALI, Swain S, Ciancio G. Rarely described renal malignancies associated with venous tumor thrombus. Anticancer Res. 2022;42:1351–8.

    Article  PubMed  Google Scholar 

  3. Marshall FF, Dietrick DD, Baumgartner WA, Reitz BA. Surgical management of renal cell carcinoma with intracaval neoplastic extension above the hepatic veins. J Urol. 1988;139:1166–71.

    Article  CAS  PubMed  Google Scholar 

  4. Abel EJ, Carrasco A, Karam J, Tamboli P, Delacroix S, Vaporciyan AA, et al. Positive vascular wall margins have minimal impact on cancer outcomes in patients with non-metastatic renal cell carcinoma (RCC) with tumour thrombus. BJU Int. 2014;114:667–73.

    Article  PubMed  Google Scholar 

  5. Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H. The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int. 2004;94:33–41.

    Article  PubMed  Google Scholar 

  6. Novick AC. Laparoscopic and partial nephrectomy. Clin Cancer Res. 2004;10:6322S-6327S.

    Article  PubMed  Google Scholar 

  7. Ljungberg B, Albiges L, Abu-Ghanem Y, Bensalah K, Dabestani S, Fernández-Pello S, et al. European Association of urology guidelines on renal cell carcinoma: the 2019 update. Eur Urol. 2019;75:799–810.

    Article  PubMed  Google Scholar 

  8. Vuong N-S, Ferriere J-M, Michiels C, Calen L, Tesi L, Capon G, et al. Robot-assisted versus open surgery for radical nephrectomy with level 1–2 vena cava tumor thrombectomy: a French monocenter experience (UroCCR study #73). Minerva Urol Nephrol. 2021. https://doi.org/10.23736/S2724-6051.20.04052-7.

    Article  PubMed  Google Scholar 

  9. Hsieh JJ, Purdue MP, Signoretti S, Swanton C, Albiges L, Schmidinger M, et al. Renal cell carcinoma. Nat Rev Dis Primers. 2017;3:17009.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: a need to reassess treatment effect. JNCI J Natl Cancer Inst. 2006;98:1331–4.

    Article  PubMed  Google Scholar 

  11. Gupta K, Miller JD, Li JZ, Russell MW, Charbonneau C. Epidemiologic and socioeconomic burden of metastatic renal cell carcinoma (mRCC): a literature review. Cancer Treat Rev. 2008;34:193–205.

    Article  PubMed  Google Scholar 

  12. Rini BI, Campbell SC, Escudier B. Renal cell carcinoma. The Lancet. 2009;373:1119–32.

    Article  CAS  Google Scholar 

  13. Bigot P, Barthelemy P, Boissier R, Khene Z-E, Pettenati C, Bernhard J-C, et al. French AFU Cancer Committee Guidelines—update 2022–2024: management of kidney cancer. Prog Urol. 2022;32:1195–274.

    Article  CAS  PubMed  Google Scholar 

  14. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.

    Article  PubMed  Google Scholar 

  15. Jonasch E, Walker CL, Rathmell WK. Clear cell renal cell carcinoma ontogeny and mechanisms of lethality. Nat Rev Nephrol. 2021;17:245–61.

    Article  CAS  PubMed  Google Scholar 

  16. Mendhiratta N, Muraki P, Sisk AE, Shuch B. Papillary renal cell carcinoma: review. Urol Oncol Semin Orig Investig. 2021;39:327–37.

    Google Scholar 

  17. Garje R, Elhag D, Yasin HA, Acharya L, Vaena D, Dahmoush L. Comprehensive review of chromophobe renal cell carcinoma. Crit Rev Oncol Hematol. 2021;160: 103287.

    Article  PubMed  Google Scholar 

  18. Vanderbruggen W, Claessens M , De Coninck V, Duchateau A , Gevaert T , Joniau S , et al. Collecting duct renal cell carcinoma: a single centre series and review of the literature. Cent Eur J Urol. 2022;75(3):252–56. https://doi.org/10.5173/ceju.2022.0143.

  19. Cohen HT, McGovern FJ. Renal-cell carcinoma. N Engl J Med. 2005;353:2477–90.

    Article  CAS  PubMed  Google Scholar 

  20. Bahadoram S, Davoodi M, Hassanzadeh S, Bahadoram M, Barahman M, Mafakher L. Renal cell carcinoma: an overview of the epidemiology, diagnosis, and treatment. Giornale Italiano di Nefrologia. 2022;39(3):2022-vol3.

  21. Novacescu D, Feciche BO, Cumpanas AA, Bardan R, Rusmir AV, Bitar YA, et al. Contemporary clinical definitions, differential diagnosis, and novel predictive tools for renal cell carcinoma. Biomedicines. 2022;10:2926.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Alam R, Patel HD, Osumah T, Srivastava A, Gorin MA, Johnson MH, et al. Comparative effectiveness of management options for patients with small renal masses: a prospective cohort study. BJU Int. 2019;123:42–50.

    Article  PubMed  Google Scholar 

  23. Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007;178:41–6.

    Article  PubMed  Google Scholar 

  24. Sidana A, Goyal J, Aggarwal P, Verma P, Rodriguez R. Determinants of outcomes after resection of renal cell carcinoma with venous involvement. Int Urol Nephrol. 2012;44:1671–9.

    Article  PubMed  Google Scholar 

  25. Bhindi B, Abel EJ, Albiges L, Bensalah K, Boorjian SA, Daneshmand S, et al. Systematic review of the role of cytoreductive nephrectomy in the targeted therapy era and beyond: an individualized approach to metastatic renal cell carcinoma. Eur Urol. 2019;75:111–28.

    Article  PubMed  Google Scholar 

  26. Fontana F, Deho F, Piacentino F, Curti M, Capogrosso P, Coppola A, et al. Management of renal cell carcinoma with extensive caval thrombosis utilizing a temporary atrial caval filter through a combined endovascular and open surgical technique. Vasc Endovascular Surg. 2021;55:505–9.

    Article  PubMed  Google Scholar 

  27. Lawindy SM, Kurian T, Kim T, Mangar D, Armstrong PA, Alsina AE, et al. Important surgical considerations in the management of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumour thrombus. BJU Int. 2012;110:926–39.

    Article  PubMed  Google Scholar 

  28. Jurado A, Romeo A, Gueglio G, Marchiñena PG. Current trends in management of renal cell carcinoma with venous thrombus extension. Curr Urol Rep. 2021;22:23.

    Article  PubMed  Google Scholar 

  29. Liu Z, Zhang Q, Zhao X, Zhu G, Tang S, Hong P, et al. Inferior vena cava interruption in renal cell carcinoma with tumor thrombus: surgical strategy and perioperative results. BMC Surg. 2021;21:402.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kaptein FHJ, van der Hulle T, Braken SJE, van Gennep EJ, Buijs JT, Burgmans MC, et al. Prevalence, treatment, and prognosis of tumor thrombi in renal cell carcinoma. JACC CardioOncol. 2022;4:522–31.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Duda A, Hanak C, Wirtz P, Lipscomb A, Mitiek M. Single-stage resection with intraoperative filter placement for right renal carcinoma with vena cava extension. J Vasc Surg Cases Innov Tech. 2021;7:691–3.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Woodruff DY, van Veldhuizen P, Muehlebach G, Johnson P, Williamson T, Holzbeierlein JM. The perioperative management of an inferior vena caval tumor thrombus in patients with renal cell carcinoma. Urol Oncol Semin Orig Investig. 2013;31:517–21.

    Google Scholar 

  33. Ghoreifi A, Djaladat H. Surgical tips for inferior vena cava thrombectomy. Curr Urol Rep. 2020;21:51.

    Article  PubMed  Google Scholar 

  34. Adams LC, Ralla B, Bender Y-NY, Bressem K, Hamm B, Busch J, et al. Renal cell carcinoma with venous extension: prediction of inferior vena cava wall invasion by MRI. Cancer Imaging. 2018;18:17.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Toprak U, Erdoğan A, Gülbay M, Karademir MA, Paşaoğlu E, Akar OE. Pre-operative evaluation of renal anatomy and renal masses with helical CT, 3D-CT and 3D-CT angiography. Diagn Interv Radiol. 2005;11:35–40.

    PubMed  Google Scholar 

  36. Ciancio G. Inferior vena cava reconstruction using a ringed polytetrafluoroethylene interposition graft and inferior vena cava filter placement following resection of renal cell carcinoma with a tumor thrombus directly infiltrating the inferior vena cava. Vasc Endovasc Surg. 2022;56:5–10.

    Article  Google Scholar 

  37. Salsano G, Palermo B, Barattini M, Puccianti F, Gentilli S, Romano N, et al. Pre-operative renal artery embolization in laparoscopic radical and partial nephrectomy: a multidisciplinary approach to renal tumors. Surg Technol Int. 2020;36:23–8.

    PubMed  Google Scholar 

  38. Zhuo L, Guodong Z, Xun Z, Shiying T, Peng H, Li Z, et al. A modified surgical technique of shortening renal ischemia time in left renal cancer patients with Mayo level II-IV tumor thrombus. BMC Surg. 2020;20:120.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Morris PD, Furtado R, Pulitano C, Crawford M, Yeo D, Vasilaras A, et al. Inferior vena cava resection and reconstruction with bovine pericardium for renal cell carcinoma: complications and outcomes. Urology. 2019;134:143–7.

    Article  PubMed  Google Scholar 

  40. Hua Y-B, Li X, Wang D-X. Prevalence and risk factors of myocardial and acute kidney injury following radical nephrectomy with vena cava thrombectomy: a retrospective cohort study. BMC Anesthesiol. 2021;21:243.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Novick AC, Kaye MC, Cosgrove DM, Angermeier K, Pontes JE, Montie JE, et al. Experience with cardiopulmonary bypass and deep hypothermic circulatory arrest in the management of retroperitoneal tumors with large vena caval thrombi. Ann Surg. 1990;212:472–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Kalapara AA, Frydenberg M. The role of open radical nephrectomy in contemporary management of renal cell carcinoma. Transl Androl Urol. 2020;9:3123–39.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Joseph S, Stuart H, Glenn P, Roger D. Surgical approaches for open renal surgery, including open radical nephrectomy. Hinman’s Atlas of urologic surgery. 4th ed. Philadelphia: Elsevier; 2019. p. 61–75.

    Google Scholar 

  44. Kishore TA, Pathrose G, Raveendran V, Ganpule A, Gautam G, Laddha A, et al. Robot-assisted laparoscopic radical nephrectomy and inferior vena cava thrombectomy: a multicentre Indian experience. Arab J Urol. 2020;18:124–8.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Pulford C, Keating K, Rohloff M, Peifer D, Eames R, Shakuri-Rad J, et al. Robotic-assisted nephrectomy with level II IVC thrombectomy using Rummel Tourniquets. Int Braz J Urol. 2022;48:196–7.

    Article  PubMed  Google Scholar 

  46. Chopra S, Simone G, Metcalfe C, de Castro Abreu AL, Nabhani J, Ferriero M, et al. Robot-assisted level II–III inferior vena cava tumor thrombectomy: step-by-step technique and 1-year outcomes. Eur Urol. 2017;72:267–74.

    Article  PubMed  Google Scholar 

  47. Metcalfe C, Chang-Kit L, Dumitru I, MacDonald S, Black P. Antegrade balloon occlusion of inferior vena cava during thrombectomy for renal cell carcinoma. Can Urol Assoc J. 2013;4:105.

    Article  Google Scholar 

  48. Crisan N, Andras I, Grad D-L, Telecan T, Coman R-T, de Cobelli O, et al. Dual combined laparoscopic approach for renal-cell carcinoma with renal vein and level I–II inferior vena cava thrombus: our technique and initial results. J Endourol. 2018;32:837–42.

    Article  PubMed  Google Scholar 

  49. Swierzewski DJ, Swierzewski MJ, Libertino JA. Radical nephrectomy in patients with renal cell carcinoma with venous, vena caval, and atrial extension. Am J Surg. 1994;168:205–9.

    Article  CAS  PubMed  Google Scholar 

  50. Ciancio G, Shirodkar SP, Soloway MS, Salerno TA. Techniques for avoidance of sternotomy and cardiopulmonary bypass during resection of extensive renal cell carcinoma with vena caval tumor thrombus extension above the diaphragm. J Card Surg. 2009;24:657–60.

    Article  PubMed  Google Scholar 

  51. Bokka S, Manikandan R, Dorairajan LN, Srivathsa K, Sreenivasan Sreerag K, Kalra S, et al. Perioperative and oncological outcomes of renal cell carcinoma with venous tumour thrombus. Urol J. 2022;89:31–7.

    Article  Google Scholar 

  52. Shuch B, Crispen PL, Leibovich BC, LaRochelle JC, Pouliot F, Pantuck AJ, et al. Cardiopulmonary bypass and renal cell carcinoma with level IV tumour thrombus: can deep hypothermic circulatory arrest limit perioperative mortality? BJU Int. 2011;107:724–8.

    Article  PubMed  Google Scholar 

  53. Marshall FF, Reitz BA, Diamond DA. A new technique for management of renal cell carcinoma involving the right atrium: hypothermia and cardiac arrest. J Urol. 1984;131:103–7.

    Article  CAS  PubMed  Google Scholar 

  54. Pouliot F, Shuch B, LaRochelle JC, Pantuck A, Belldegrun AS. Contemporary management of renal tumors with venous tumor thrombus. J Urol. 2010;184:833–41.

    Article  PubMed  Google Scholar 

  55. Sood A, Jeong W, Barod R, Bahnson E, Kirura P, Abdollah F, et al. Robot-assisted hepatic mobilization and control of suprahepatic infradiaphragmatic inferior vena cava for level 3 vena caval thrombectomy: an IDEAL stage 0 study. J Surg Oncol. 2015;112:741–5.

    Article  PubMed  Google Scholar 

  56. Wang B, Huang Q, Liu K, Fan Y, Peng C, Gu L, et al. Robot-assisted level III–IV inferior vena cava thrombectomy: initial series with step-by-step procedures and 1-year outcomes. Eur Urol. 2020;78:77–86.

    Article  CAS  PubMed  Google Scholar 

  57. Kundavaram C, de Castro Abreu AL, Chopra S, Simone G, Sotelo R, Aron M, et al. Advances in robotic vena cava tumor thrombectomy: intracaval balloon occlusion, patch grafting, and vena cavoscopy. Eur Urol. 2016;70:884–90.

    Article  PubMed  Google Scholar 

  58. Ciancio G, Hawke C, Soloway M. The use of liver transplant techniques to aid in the surgical management of urological tumors. J Urol. 2000. https://doi.org/10.1097/00005392-200009010-00012.

    Article  PubMed  Google Scholar 

  59. Serag H, Featherstone JM, Griffiths DF, Mehta D, Dunne J, Hughes O, et al. Radical nephrectomy and intracaval thrombectomy for advanced renal cancer with extensive inferior vena cava involvement utilising cardiopulmonary bypass and hypothermic circulatory arrest: is it worthwhile? Arab J Urol. 2018;16:378–85.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Liu Z, Zhao X, Ge L, Wu B, Tang S, Hong P, et al. Completely laparoscopic versus open radical nephrectomy and infrahepatic tumor thrombectomy: comparison of surgical complexity and prognosis. Asian J Surg. 2021;44:641–8.

    Article  PubMed  Google Scholar 

  61. Shao P, Li J, Qin C, Lv Q, Ju X, Li P, et al. Laparoscopic radical nephrectomy and inferior vena cava thrombectomy in the treatment of renal cell carcinoma. Eur Urol. 2015;68:115–22.

    Article  PubMed  Google Scholar 

  62. Lue K, Russell CM, Fisher J, Kurian T, Agarwal G, Luchey A, et al. Predictors of post-operative complications in patients who undergo radical nephrectomy and IVC thrombectomy: a large contemporary tertiary center analysis. Clin Genitourin Cancer. 2016;14:89–95.

    Article  PubMed  Google Scholar 

  63. Ciancio G, Manoharan M, Katkoori D, De Los SR, Soloway MS. Long-term survival in patients undergoing radical nephrectomy and inferior vena cava thrombectomy: single-center experience. Eur Urol. 2010;57:667–72.

    Article  PubMed  Google Scholar 

  64. Tabbara MM, González J, Ciancio G. The surgical evolution of radical nephrectomy and tumor thrombectomy: a narrative review. Ann Transl Med. 2023;11:262–262.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Bansal RK, Tu HYV, Drachenberg D, Shayegan B, Matsumoto E, Whelan JP, et al. Laparoscopic management of advanced renal cell carcinoma with renal vein and inferior vena cava thrombus. Urology. 2014;83:812–7.

    Article  PubMed  Google Scholar 

  66. Disanto V, Pansadoro V, Portoghese F, Scalese GA, Romano M. Retroperitoneal laparoscopic radical nephrectomy for renal cell carcinoma with infrahepatic vena caval thrombus. Eur Urol. 2005;47:352–6.

    Article  PubMed  Google Scholar 

  67. Gu L, Ma X, Gao Y, Li H, Li X, Chen L, et al. Robotic versus open level I–II inferior vena cava thrombectomy: a matched group comparative analysis. J Urol. 2017;198:1241–6.

    Article  PubMed  Google Scholar 

  68. Labbate C, Hatogai K, Werntz R, Stadler WM, Steinberg GD, Eggener S, et al. Complete response of renal cell carcinoma vena cava tumor thrombus to neoadjuvant immunotherapy. J Immunother Cancer. 2019;7:66.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. School of Medicine, Alborz University of Medical Sciences, Karaj, Iran

    Ali Faegh

  2. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Aysan Moeinafshar

  3. Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran

    Nima Rezaei

  4. Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Nima Rezaei

  5. Children’s Medical Center Hospital, Dr. Qarib St, Keshavarz Blvd, Tehran, 14194, Iran

    Nima Rezaei

Authors
  1. Ali Faegh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aysan Moeinafshar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nima Rezaei
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AF and AM wrote the main documents and prepared figures and tables. NR reviewed the manuscript and supervised the project.

Corresponding author

Correspondence to Nima Rezaei.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval (Research involving human participants and/or animals) and Informed consent

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Faegh, A., Moeinafshar, A. & Rezaei, N. Nephrectomy and IVC thrombectomy in renal cancer: a narrative review. Clin Transl Oncol 26, 574–583 (2024). https://doi.org/10.1007/s12094-023-03302-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-023-03302-6

Keywords

Search

Navigation