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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. [PMID: 33554309 DOI: 10.1007/s11934-021-01036-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW To review the evidence regarding the current trends in surgical management of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombosis. Recent published series have shown the role of minimally invasive surgery in IVC thrombectomy. This review article evaluates the present RCC with venous extent literature to assess the role of open and minimally invasive surgery in this scenario. RECENT FINDINGS Robotic urological surgery has shown to have known benefits in radical prostatectomy, partial nephrectomy, and pyeloplasty. Recent published series showed feasibility of robotic IVC thrombectomy even for level IV cases. With growing number of robot-assisted and laparoscopic surgeries worldwide, there is a current tendency to treat this complex and challenging pathology with a minimally invasive approach, without compromising oncological outcomes.
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Affiliation(s)
- Alberto Jurado
- Urology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Agustin Romeo
- Urology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina.
| | - Guillermo Gueglio
- Urology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Patricio Garcia Marchiñena
- Urology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
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Novotny R, Chlupac J, Marada T, Borovicka V, Vik V, Voska L, Janousek L, Fronek J. Transabdominal two-cavity approach for radical nephrectomy combined with inferior vena cava thrombectomy for malignant thrombus caused by renal cell carcinoma: a case series. J Med Case Rep 2018; 12:313. [PMID: 30355283 PMCID: PMC6201631 DOI: 10.1186/s13256-018-1845-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advanced renal cell carcinoma in some cases causes malignant intravascular thrombus with the potential for growth into the inferior vena cava or even the right atrium. Renal cell carcinoma is accompanied by malignant intravascular thrombus in up to 10% of cases. We present an overview of three patients diagnosed as having renal cell carcinoma with malignant intravascular thrombus requiring radical nephrectomy combined with inferior vena cava thrombectomy. CASE PRESENTATION Three patients diagnosed as having renal cell carcinoma were indicated for renal cell carcinoma combined with inferior vena cava thrombectomy between 2014 and 2017 at our department: a 69-year-old white Caucasian woman, a 74-year-old white Caucasian woman, and a 58-year-old white Caucasian woman. According to the Novick classification of inferior vena cava tumor thrombus, there was one infrahepatic (level II) and two supradiaphragmatic (level IV) malignant intravascular thrombi. The average age of these patients was 67 years (range 58-74 years). All patients underwent radical nephrectomy combined with inferior vena cava thrombectomy through transabdominal approach. In patients with level IV malignant intravascular thrombus, transesophageal echocardiogram was used to guide the placement of the inferior vena cava cross-clamp above the diaphragm. In one patient the pericardium was opened to place a cross-clamp above a tumor just below the right atrium. There were no postoperative mortalities to date with an average follow-up of 23 months (range 2-48 months). To date, no patient has demonstrated recurrent inferior vena cava malignant intravascular thrombus requiring secondary inferior vena cava thrombectomy or any other treatment. A comparison of estimated blood loss and transfusion rate was not significantly different in all three cases. CONCLUSION Despite the technical complexity of the procedure, caval thrombectomy combined with radical nephrectomy currently represents the only radical treatment for renal cell carcinoma accompanied by malignant intravascular thrombus with good mid-term oncological outcomes.
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Affiliation(s)
- R Novotny
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Videnska1958/9, 14021, Prague, Czech Republic
| | - J Chlupac
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Videnska1958/9, 14021, Prague, Czech Republic.,Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - T Marada
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Videnska1958/9, 14021, Prague, Czech Republic
| | - V Borovicka
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Videnska1958/9, 14021, Prague, Czech Republic
| | - V Vik
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Videnska1958/9, 14021, Prague, Czech Republic
| | - L Voska
- Department of Pathology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - L Janousek
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Videnska1958/9, 14021, Prague, Czech Republic.,First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Fronek
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Videnska1958/9, 14021, Prague, Czech Republic. .,First Faculty of Medicine, Charles University, Prague, Czech Republic. .,Second Faculty of Medicine, Charles University, Prague, Czech Republic.
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Anesthetic management of renal cavoatrial tumor thrombus during partial cardiopulmonary bypass. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:658-663. [PMID: 32082813 DOI: 10.5606/tgkdc.dergisi.2018.16685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/16/2018] [Indexed: 11/21/2022]
Abstract
A 58-year-old male patient was scheduled for the surgical removal of a cavoatrial thrombus and renal tumors during cardiopulmonary bypass without circulatory arrest. Throughout the operation, continuous monitoring for pulmonary embolism was carried out by transesophageal echocardiography. A multidisciplinary team including anesthetists, urologists, and cardiovascular and gastrointestinal surgeons performed the operation successfully. This case report highlights the importance of anesthetic management in renal-cell carcinoma patients with a cavoatrial thrombus.
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Xiao X, Zhang L, Chen X, Cui L, Zhu H, Pang D, Yang Y, Wang Q, Wang M, Gao C. Surgical Management of Renal Cell Carcinoma Extending Into Venous System: A 20-Year Experience. Scand J Surg 2017; 107:158-165. [PMID: 29141518 DOI: 10.1177/1457496917738922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS The purpose of this study is to report our 20-year experience with the surgical management of renal cell carcinoma extending into the inferior vena cava using a novel classification system. MATERIALS AND METHODS We retrospectively reviewed the data of 103 patients (69 males, 34 females, mean age: 52.9 ± 12.6 years) with renal cell carcinoma involving the venous system treated between 1993 and 2014. The inferior vena cava tumor thrombus was classified into five levels: 0 (renal vein, n = 12), 1 (infrahepatic, n = 33), 2a (low retrohepatic, n = 26), 2b (high retrohepatic, n = 19), and 3 (supradiaphragmatic, n = 13). Clinical data were summarized, and overall survival, cancer-specific survival, and disease-free survival were examined by Cox regression analysis. RESULTS All patients underwent radical surgery. Complete resections of the renal tumor and thrombus were achieved in 101 patients (98.1%). Two intraoperative and one postoperative in-hospital deaths (2.9%) occurred. In total, 19 patients (18.8%) had a total of 29 postoperative complications. Mean follow-up time was 46 months (range, 1-239 months). The 5- and 10-year overall survival rates were 62.9% and 56.0%, respectively. Metastasis, rather than thrombus level, was a significant risk factor associated with overall survival (hazard ratio = 4.89, 95% confidence interval: 2.24-10.67, p < 0.001). CONCLUSION Our novel classification system can be used to select the optimal surgical approach and method for patients with renal cell carcinoma and venous thrombus. Its use is associated with prolonged survival and relatively few complications. Metastasis is an independent risk factor of overall survival.
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Affiliation(s)
- X Xiao
- 1 Department of Urology, General Hospital of Chinese People's Armed Police Forces, Beijing, China.,2 Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - L Zhang
- 2 Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - X Chen
- 1 Department of Urology, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - L Cui
- 3 Department of Urology, General Hospital of Civil Aviation Administration of China, Beijing, China
| | - H Zhu
- 1 Department of Urology, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - D Pang
- 1 Department of Urology, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - Y Yang
- 2 Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Q Wang
- 4 Department of Cardiac Surgery, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - M Wang
- 5 Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
| | - C Gao
- 6 Department of Cardiac Surgery, Chinese PLA General Hospital, Beijing, China
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Bertini R, Roscigno M, Lapenna E, Pasta A, Petralia G, Strada E, Naspro R, Da Pozzo L, Colombo R, Rigatti P. Radical Nephrocapsulectomy and Caval Thrombectomy with Extracorporeal Circulation and Deep Hypothermic Circulatory Arrest in Right Anterior Minithoracotomy: A Minimally Invasive Approach. Urology 2008; 71:957-61. [DOI: 10.1016/j.urology.2007.11.122] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 11/12/2007] [Accepted: 11/20/2007] [Indexed: 10/22/2022]
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Abstract
This article describes the principles, attributes, and pitfalls of the many MR imaging approaches available for assessment of renal-related disorders. Tables 1 and 2 summarize the specific approach and rationale.
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Affiliation(s)
- Jingbo Zhang
- Department of Radiology, Beth Israel Deaconess Medical Center, Shapiro 4 Clinical Center, 330 Brookline Avenue, Boston, MA 02215, USA
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Vaidya A, Ciancio G, Soloway M. Surgical techniques for treating a renal neoplasm invading the inferior vena cava. J Urol 2003. [PMID: 12544285 DOI: 10.1016/s0022-5347(05)63931-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Historically inferior vena caval thrombus associated with renal cell carcinoma was a deterrent to surgery. During the last 3 decades there has been steady improvement in surgical techniques and perioperative care, which has dramatically improved the ability to resect safely these tumors. We acknowledge these improvements in chronological order. MATERIALS AND METHODS A comprehensive literature review of the different techniques used for resecting renal cell carcinoma with inferior vena caval involvement was performed using MEDLINE. Data focused on surgical techniques, including various incisions, exposures, adjuncts to surgery and outcomes. RESULTS Tumor thrombus associated with renal cell carcinoma is no longer considered to have a detrimental impact on survival. Patients who are acceptable surgical candidates have survival rates as high as 68%. Although there is a great deal of emphasis on the importance of an aggressive surgical approach, a uniform operative strategy based on the level of the tumor thrombus has not been established. Surgical techniques derived from liver transplant surgery and cardiac arrest with cardiopulmonary bypass have drastically decreased operative complications associated with extensive involvement of the inferior vena cava with tumor thrombus. CONCLUSIONS The only curative approach to renal cell carcinoma is surgery. An aggressive approach is warranted when tumor involves the renal vein and inferior vena cava. Surgical strategy depends on the level of the inferior vena caval thrombus. Patients with extension of the thrombus above the diaphragm are a greater technical challenge. Hypothermic circulatory arrest should be considered when treating vena caval-atrial tumor thrombus. Surgeons familiar with liver mobilization can greatly facilitate the exposure needed for safely operating in these cases.
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Affiliation(s)
- Anil Vaidya
- Department of Urology, University of Miami School of Medicine, Miami, Florida, USA
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CIANCIO GAETANO, HAWKE CHRISTOPHER, SOLOWAY MARK. THE USE OF LIVER TRANSPLANT TECHNIQUES TO AID IN THE SURGICAL MANAGEMENT OF UROLOGICAL TUMORS. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67277-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- GAETANO CIANCIO
- From the Departments of Surgery (Division of Transplantation) and Urology, University of Miami School of Medicine, Miami, Florida
| | - CHRISTOPHER HAWKE
- From the Departments of Surgery (Division of Transplantation) and Urology, University of Miami School of Medicine, Miami, Florida
| | - MARK SOLOWAY
- From the Departments of Surgery (Division of Transplantation) and Urology, University of Miami School of Medicine, Miami, Florida
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