Abstract
Renal cell carcinoma produces neoplasmatic thrombus that usually invades and progressively grows into the endorenal veins. The thrombus may extend into the ipsilateral renal vein or the inferior vena cava in 15-20% and 8-15% of cases, respectively. These tumors are classified into four categories (I, II, III, and IV) according to the level of cephalad extension of thrombus into the inferior vena cava. The purpose of this study was to assess the surgical strategy for cases of renal tumor thrombus invading the vena cava. We retrospectively reviewed the records of 10 patients with renal cell carcinoma, who underwent in our institution radical nephrectomy and resection of vena cava thrombus between January 1997 and December 2004. Four patients were classified as level I, four were level II, and two were level III. In all cases, the thrombus was removed through a small cavotomy without cardiopulmonary bypass and the cavotomy was closed primarily. Pringle’s maneuver was performed in the two level III cases. There were no perioperative pulmonary embolisms or deaths, and the mean hospital stay was 8 ± 1.1 days. The mean survival was 21.8 ± 8 months, and the vena cava remained patent for this period. Tumor thrombectomy improves the prognosis and the quality of life of these patients, and in most of cases the surgical technique, although challenging, carries a low morbidity and mortality rate.
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Bower TC, Stanson A. Diagnosis and management of tumors of the inferior vena cava. In: Rutherford RB (ed), Vascular Surgery. Philadelphia: WB Saunders, 2000, pp 2077–2092
Bower TC, Cherry KJ. Primary and secondary vena cava tumors. In: Ernst CB, Stanley JC (eds), Current Therapy in Vascular Surgery. St Louis, Mosby, 2001, pp 905–910.
Kim HL, Zisman A, Han KR, Figlin RA, Belldegrun AS. Prognostic significance of venous thrombus in renal cell carcinoma. Are renal vein and inferior vena cava involvement different? J Urol 2004;171:588–591
Zisman A, Wieder JA, Pantuck AJ, et al. Renal cell carcinoma with tumor thrombus extension: biology, role of nephrectomy and response to immunotherapy. J Urol 2003;169:909–916
Pritchett TR, Lieskovsky G, Skinner DG. Extension of renal cell carcinoma into the vena cava: clinical review and surgical approach. J Urol 1986;135:460–464
Cherrie RJ, Goldman DG, Lindner A, DeKernion JB. Prognostic implications of vena cava extension of renal cell carcinoma. J Urol 1982;128:910–912
Neves RJ, Zincke H. Surgical treatment of renal cancer with vena cava extension. Br J Urol 1987;59:390–395
Vaidya A, Ciancio G, Soloway M. Surgical techniques for treating a renal neoplasm invading the inferior vena cava. J Urol 2003;169:435–444
Schwerk WB, Schwerk WN, Rodek G. Venous renal tumor extension: a prospective US evaluation. Radiology 1985;156:491–495
Oikawa T, Shimazui T, Johraku A, et al. Intraoperative transesophageal echocardiography for inferior vena caval tumor thrombus in renal cell carcinoma. Int J Urol 2004;11:189–192
Robson CJ. Radical nephrectomy for renal cell carcinoma. J Urol 1963;89:37–41
Couillard DR, Vere White RW. Surgery of renal cell carcinoma. Urol Clin North Am 1993;20:263–275
Skinner DG, Pfister RF, Colin R. Extension of renal cell carcinoma into the vena cava: the rationale for aggressive surgical management. J Urol 1972;107:711–716
Nesbitt JC, Soltero ER, Dinney CPN. Surgical management of renal cell carcinoma with inferior vena cava tumor thrombus. Ann Thorac Surg. 1997;63:1592–1600
Jibiki M, Iwai T, Inoue Y, et al. Surgical strategy for treating renal cell carcinoma with thrombus extending into the inferior vena cava. J Vasc Surg 2004;39:829–835
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. Br J Urol 2004;94:33–41
Bissada NK, Yakoot HH, Babanouri A, et al. Long-term experience with management of renal cell carcinoma involving the inferior vena cava. Urology 2003;61:89–92
Tsuji Y, Matsuda H, Hara I, Yoshimura M, Okita Y. Aortic and vena caval reconstruction with retroperitoneal lymph node dissection for metastatic germ cell tumor. Vasa 2005;34:140–143
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Papadimitriou, D.K., Pitoulias, G.A., Tachtsi, M.D. et al. Surgical Treatment of Renal Neoplasmatic Thrombi Extending into the Inferior Vena Cava. Ann Vasc Surg 20, 223–227 (2006). https://doi.org/10.1007/s10016-006-9001-7
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DOI: https://doi.org/10.1007/s10016-006-9001-7