Tumor Thrombectomy Overview and General Concepts
The extension of a malignant tumor into major vascular structures is overall a rare occurrence. Nevertheless, intravascular involvement represents a challenge for management of the patient and has been associated with a worse prognosis. Surgical embolectomy and primary resection in the organ of tumor origin is the gold standard for management although alternative methods of treatment have also been published. Surgical embolectomy requires a thorough workup and meticulous surgical planning, including coordination with a multidisciplinary. The surgical procedure is challenging for both the surgical team and the anesthesia team who must anticipate the need for blood products, fluid balance, and pain management. The enhanced recovery pathway, beginning in the preoperative setting, as well as prudent follow up monitoring can improve the prognosis for these cases.
KeywordsTumor thrombectomy Inferior vena cava thrombus Renal cell carcinoma Hepatocellular carcinoma Tumor embolectomy
- 1.American Cancer Society. Cancer facts & figures 2018. 2018. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2018/cancer-facts-and-figures-2018.pdf. Accessed 20 Apr 2018.
- 3.Sakamoto K, Nagano H. Outcomes of surgery for hepatocellular carcinoma with tumor thrombus in the inferior vena cava or right atrium. Surgery Today. 2018;48(9):819–24. https://doi.org/10.1007/s00595-017-1619-2.
- 4.Hutchinson R, Rew R, Chen G, et al. The adverse survival implications of bland thrombus in renal cell carcinoma with venous tumor thrombus. J Urol. 2018;18:30176–6. https://doi.org/10.1016/j.urology.2018.02.019.
- 7.Haddad A, Wood CG, Abel EJ, et al. Oncologic outcomes following surgical resection of renal cell carcinoma with inferior vena caval thrombus extending above the hepatic veins: a contemporary multicenter cohort. J Urol. 2014;192:1050–6. https://doi.org/10.1016/j.juro.2014.03.111.CrossRefPubMedGoogle Scholar