The incidence of renal cell carcinoma continues to rise secondary to increased imaging utilization with the majority of new cases being lower stages based on size criteria. The incidence of larger renal tumors with known propensities for venous thrombus formation is still present and remains a challenge for the urological community in terms of surgical treatment with acceptable oncological outcomes and limited complications. Proper staging and preoperative imaging are crucial to determine the best approach with limited morbidity.
As previously described by multiple authors and institutions, the level of tumor thrombus is one if not the most important factor in determining the surgical approach. We detail our approach model and surgical technique in great detail with respect to thrombus within the renal vein, extending into the inferior vena cava and extending into the right atrium.
This chapter also provides data and technical descriptions from our contemporaries at other institutions describing alternative approaches. This latter section can be of utmost importance during any surgical procedures in which unanticipated complications can arise. We have also included our own personal experience with this patient population which is one of the largest within the urological community.
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.
Marshall VF, Middleton RG, Holswade GR, Goldsmith EI. Surgery for renal cell carcinoma in the vena cava. J Urol. 1970;103:414–20.PubMedGoogle Scholar
Scheft P, Novick AC, Strafton RA, Stewart BH. Surgery for renal cell carcinoma extending into the vena cava. J Urol. 1978;120:28–31.Google Scholar
Robson CJ, Churchill BM, Anderson W. The results of radical nephrectomy for renal cell carcinoma. J Urol. 1969;101:297–301.PubMedGoogle Scholar
Glaser A, Novick AC. Long-term follow-up after surgical treatment for renal cell carcinoma extending into the right atrium. J Urol. 1996;155:448–50.Google Scholar
Zisman A, Wieder JA, Pantuck AJ. Renal cell carcinoma with tumor thrombus extension: biology, role of nephrectomy and response to immunotherapy. J Urol. 2003;169:909–16.PubMedCrossRefGoogle Scholar
Moinzadeh A, Libertino J. Prognostic significance of tumor thrombus level in patients with renal cell carcinoma and venous thrombus extension. Is all T3b the same? J Urol. 2004;171:598–601.PubMedCrossRefGoogle Scholar
Kim HL, Belledegrun AS, Freitas DG. Paraneoplastic signs and symptoms of renal cell carcinoma: implications for prognosis. J Urol. 2003;170:1742–6.PubMedCrossRefGoogle Scholar
Zini L, Destriuex-Garnier L, Leroy X. Renal vein ostium invasion of renal cell carcinoma with an inferior vena cava thrombus: prediction by renal and vena caval vein diameters and prognostic significance. J Urol. 2008;179(2):450–4.PubMedCrossRefGoogle Scholar
Lam JS, et al. Evolving principles of surgical management and prognostic factors for outcome in renal cell carcinoma. J Clin Oncol. 2006;24:5565–75.PubMedCrossRefGoogle Scholar
Nakano H, et al. Treatment of renal cancer patients by transcatheter embolization and its effects on lymphocyte proliferative responses. J Urol. 1983;130:24–7.PubMedGoogle Scholar
Bakke A, et al. Augmentation of natural killer cell activity after arterial embolization of renal carcinomas. Cancer Res. 1982;42:3880–3.PubMedGoogle Scholar
Schwartz MJ, et al. Renal artery embolization: clinical indications and experience from over 100 cases. BJU Int. 2006;99:881–6.PubMedCrossRefGoogle Scholar
Libertino JA, Zinman L, Watkins E Jr. Long-term results of resection of renal cell cancer with extension into inferior vena cava. J Urol. 1987; 137(1):21–4.Google Scholar
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(2):205–9.PubMedCrossRefGoogle Scholar
Kaag MG, Toyen C, Russo P. Cronins Radical Nephrectomy with vena caval thrombectomy: a contemporary experience. BJU Int. 2010;107:1386–93.Google Scholar
Cianco G, Vaidya A, Savoie M. Management of renal cell carcinoma with tumor thrombus in the renal and inferior vena cava: the University of Miami experience in using liver transplantation techniques. Eur Urol. 2007;51(4):988–94.CrossRefGoogle Scholar
Fitzgerald JM, Tripathy U, Svensson LG, Libertino JA. Radical nephrectomy with vena caval thrombectomy using a minimal access approach for cardiopulmonary bypass. J Urol. 1998;159(4):1292–3.PubMedCrossRefGoogle Scholar
Rabbani F, Hakimian P, Reuter V. Renal vain or inferior vena caval extension in patients with renal cortical tumors: impact of tumor histology. J Urol. 2004;172(3):1057–61.CrossRefGoogle Scholar
Kapoor A, Nguan C, Al-Ahaiji T. Laparoscopic management of advanced renal cell carcinoma with level I renal vein thrombus. Urology. 2006;68(3):514–7.PubMedCrossRefGoogle Scholar
Varkarakis I, Bhayani S, Allaf M. Laparoscopic-assisted nephrectomy with inferior vena cava tumor thrombectomy: preliminary results. Urology. 2004; 64(5):925–9.PubMedCrossRefGoogle Scholar
Abaza R. Initial series of robotic radical nephrectomy with vena caval tumor thrombectomy. Eur Urol. 2011;59:652–6.PubMedCrossRefGoogle Scholar
Kim EH, Jain S, Benway Bm, Figneshau RS. Partial nephrectomy in two patients with known T3a tumours involving the renal vain. BJU Int. 2012;109(9):1345–48.Google Scholar
Takeda H, Nakano Y, Kashiwgi Y, Yoshino. Downsizing a thrombus of advanced renal cell carcinoma in a presurgical setting with sorafenib. Urol Int. 2012;88:235–7.PubMedCrossRefGoogle Scholar
Rini BI, Garcia J, Elson P, Wood L. The effect of sunitinib on primary renal cell carcinoma and facilitation of subsequent surgery. BJU Int. 2012;1987:1548–54.Google Scholar
Barney J, Churchill E. Adenocarcinoma of the kidney with metastases to the lung: cured nephrectomy and lobectomy. J Urol. 1939;42:269–76.Google Scholar
Wotkowicz C, Libertino JA, Sorcini A, Mourtzinos A. Management of renal cell carcinoma with vena cava and atrial thrombus: minimal access vs median sternotomy with circulatory arrest. BJU Int. 2006;98:289–97.Google Scholar