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Multidisciplinary surgical approach for renal cell carcinoma with inferior vena cava tumor thrombus. Surg Today 2021; 52:1016-1022. [PMID: 34786640 DOI: 10.1007/s00595-021-02415-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/12/2021] [Indexed: 10/19/2022]
Abstract
PURPOSES The optimal surgical management of renal cell carcinoma with tumor thrombus within the inferior vena cava (IVC) remains to be clarified. METHODS Sixteen consecutive cases were reviewed. Incision, the IVC clamping position, and the venous drainage procedure were modified according to the tumor thrombus extension level: level I or II (below the hepatic vein, n = 8), level III (above the hepatic vein but below the right atrium, n = 5), and level IV (extending into the right atrium, n = 3). RESULTS For level I or II, resection could be simply achieved by clamping the IVC below the hepatic vein, without hemodynamic collapse. For level III, clamping the IVC above the hepatic vein and the hepatoduodenal ligament was required. Venous drainage from the lower body (cannulation to distal IVC) and portal system (cannulation to ileocolic vein) were applied. When opening the IVC, the significant backflow was controlled using cardiopulmonary bypass with drop-in suckers. For level IV, median sternotomy, exposure of the right atrium, and cardiopulmonary bypass were mandatory. With the combination of these approaches, the perioperative mortality rate was 0% and the 5-year overall survival rate was 52%. CONCLUSIONS A multidisciplinary surgical approach is essential, especially for level III and IV cases.
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2
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Chan F, Ngan Kee WD, Low JM. Anesthetic management of renal cell carcinoma with inferior vena caval extension. J Clin Anesth 2001; 13:585-7. [PMID: 11755329 DOI: 10.1016/s0952-8180(01)00335-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present a case of a patient with renal cell carcinoma extending into the inferior vena cava. Preoperative diagnosis was facilitated by transthoracic and transesophageal echocardiography (TEE), and inferior venacavography. Intraoperatively, monitoring with continuous TEE was used. Preparation was made for cardiopulmonary bypass but surgery was successfully completed using extracorporeal venous shunting. We discuss the important aspects of preoperative diagnosis and the intraoperative anesthetic management of this case.
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Affiliation(s)
- F Chan
- Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
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3
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Aggarwal BK, Shatapathy P, Kamath SG, Yawari GA, Krishnapillai S. Right Heart Bypass for Inferior Vena Cava Tumor Thrombus Extending into Heart. Asian Cardiovasc Thorac Ann 1999. [DOI: 10.1177/021849239900700417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Radical nephrectomy with en bloc inferior vena caval tumor thrombectomy improves survival in patients with renal cell carcinoma with a tumor thrombus extending into the inferior vena cava. Cardiopulmonary bypass with or without deep-hypothermic circulatory arrest is advocated when the tumor thrombus extends into the right heart chambers. Right heart bypass was used to remove such a tumor thrombus successfully for the first time in a patient with renal cell carcinoma.
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4
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Nomori H, Horio H, Morinaga S, Suemasu K. Minimally invasive thymoma with extensive intravascular growth. Jpn J Clin Oncol 1999; 29:630-2. [PMID: 10721946 DOI: 10.1093/jjco/29.12.630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 70-year-old male with grossly non-invasive thymic tumor associated with myasthenia gravis was subjected to thymothymectomy. Microscopic examination showed extensive intravascular tumor extensions into veins of thymic tissue and surrounding muscles and a minute direct invasion of the thymic tissue. Histologically, the tumor showed mixed-type thymoma with polygonal epithelial cells. These pathological findings indicated that the tumor cells extended mainly into vessels beyond the tumor capsule via tumor drainage veins rather than invading neighboring structures. After chemotherapy and mediastinal irradiation, the patient is now in complete remission of myasthenia gravis and is recurrence-free 15 months after surgery.
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Affiliation(s)
- H Nomori
- Department of Thoracic Surgery, Saiseikai Central Hospital, Tokyo, Japan
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5
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Yamashita C, Azami T, Okada M, Toyoda Y, Wakiyama H, Yoshida M, Ataka K, Okada M. Usefulness of cardiopulmonary bypass in reconstruction of inferior vena cava occupied by renal cell carcinoma tumor thrombus. Angiology 1999; 50:47-53. [PMID: 9924888 DOI: 10.1177/000331979905000106] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Aggressive surgical treatment in renal cell carcinoma is still controversial. The aim of this paper is to assess inferior vena caval (IVC) reconstruction for suprahepatic vena caval renal cell carcinoma (RCC) tumor thrombus. Twelve patients with suprahepatic vena caval thrombus from renal cell carcinoma who underwent surgical repair with cardiopulmonary bypass were evaluated. The vena caval defect was reconstructed by direct suture, patch repair, or graft replacement. Of 12 patients undergoing partial cardiopulmonary bypass, tumor thrombus extended to the junction of the hepatic vein in three patients and to the right atrium in one. Tumor thrombus was removed manually or with balloon catheter. Tumor thrombus in the right atrium was removed during electrical ventricular fibrillation. Repair of the IVC was performed by direct suture of the IVC wall in two patients, patch repair with expanded polytetrafluoroethylene (EPTFE) graft in seven, and graft replacement with an EPTFE graft in three. There were no operative deaths and the only postoperative complication was one patient death from pulmonary emboli. The four patients with nonlocalized disease died within 2 years, but four patients lived for more than 3 years postoperatively. Survival was 37.5% at 3 years and 18.8% at 5 years by the Kaplan-Meier's method. CONCLUSIONS (1) Partial cardiopulmonary bypass is useful for the control of bleeding when tumor thrombus in the IVC extends to the junction of the hepatic vein. (2) Nephrectomy with tumor thrombectomy of the IVC is valuable, and long-term survival is possible in patients without distant metastases or regional lymph node metastases.
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Affiliation(s)
- C Yamashita
- Department of Surgery, Division II, Kobe University School of Medicine, Japan
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6
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Gohji K, Ueno K, Gotoh A, Hara I, Okada H, Arakawa S, Kamidono S. Surgical treatment of renal cell carcinoma with tumor thrombi in the inferior vena cava. Int J Clin Oncol 1997. [DOI: 10.1007/bf02488994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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7
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Hirota S, Matsumoto S, Ichikawa S, Tomita M, Koshino T, Sako M, Kono M. Suprarenal inferior vena cava filter placement prior to transcatheter arterial embolization (TAE) of a renal cell carcinoma with large renal vein tumor thrombus: prevention of pulmonary tumor emboli after TAE. Cardiovasc Intervent Radiol 1997; 20:139-41. [PMID: 9030506 DOI: 10.1007/s002709900122] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To prevent embolization of necrotic renal vein tumor after transcatheter embolization of a left renal cell carcinoma, we placed a suprarenal Bird's nest inferior vena cava filter. The patient tolerated the procedure well and had extensive tumor infarction including the tumor thrombus on 6-month follow-up computed tomography.
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Affiliation(s)
- S Hirota
- Department of Radiology, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuoku, Kobe City, 650, Japan
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8
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Federici S, Galli G, Ceccarelli PL, Rosito P, Sciutti R, Dòmini R. Wilms' tumor involving the inferior vena cava: preoperative evaluation and management. MEDICAL AND PEDIATRIC ONCOLOGY 1994; 22:39-44. [PMID: 8232079 DOI: 10.1002/mpo.2950220108] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Neoplastic invasion of the inferior vena cava due to renal tumors (especially Wilms' tumor) is uncommon in children. The tumor thrombus, according to the aggressiveness of the original neoplasm, can extend in diverse ways, obliterate the vascular lumen completely, and even reach the right atrium. The luminal thrombus might be accompanied by the involvement of the caval wall, which requires wide vascular resection. The purpose of this paper is to present our experience with 7 children, aged 18 months and 6 years, affected by caval invasion due to Wilms' tumor. Furthermore, the diagnostic techniques and the surgical treatment in simple caval thrombosis and in associated invasion of the caval wall are described.
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Affiliation(s)
- S Federici
- Department of Pediatric Surgery, University of Bologna, Italy
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9
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Davits RJ, Blom JH, Schröder FH. Surgical management of renal carcinoma with extensive involvement of the vena cava and right atrium. BRITISH JOURNAL OF UROLOGY 1992; 70:591-3. [PMID: 1486383 DOI: 10.1111/j.1464-410x.1992.tb15825.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Between 1988 and 1990, 8 patients with a renal tumour extending into the vena cava and with supradiaphragmatic extension were treated by an operative technique involving extracorporeal circulation and deep hypothermic circulatory arrest. In 4 patients the thrombus extended into the right atrium. Six patients appeared to have a renal carcinoma. Intra-operatively one patient's tumour proved to be a metastasis of a squamous cell carcinoma of the lung and another patient was found post-operatively to have a leiomyosarcoma of the vena cava. Two of these 6 patients died from metastases 6 weeks and 8 months post-operatively. Four patients are symptom-free, although 3 of them have liver or lung metastases 10, 20 and 37 months post-operatively. One has no evidence of disease 18 months post-operatively. The use of extracorporeal circulation and deep hypothermic circulatory arrest provides optimal surgical exposure and gives the patients a considerable complaint-free interval post-operatively. How often cure is also achieved is as yet unclear.
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Affiliation(s)
- R J Davits
- Department of Urology, Erasmus University and Academic Hospital Dijkzigt, Rotterdam, The Netherlands
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10
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Yokoi K, Miyazawa N, Mori K, Saito Y, Tominaga K, Imura G, Shimamura K, Hirotani T, Kiso I. Invasive thymoma with intracaval growth into the right atrium. Ann Thorac Surg 1992; 53:507-9. [PMID: 1540072 DOI: 10.1016/0003-4975(92)90281-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report an unusual case of invasive thymoma with intracaval growth into the right atrium. Computed tomography and venacavography demonstrated this manner of extension of thymoma. The tumor was completely removed by means of cardiopulmonary bypass after four courses of chemotherapy. Multidisciplinary treatment for invasive thymoma with this growth pattern is thought to be useful.
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Affiliation(s)
- K Yokoi
- Division of Thoracic Diseases, Tochigi Cancer Center, Japan
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11
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Brenner DW, Brenner CJ, Scott J, Wehberg K, Granger JP, Schellhammer PF. Suprarenal Greenfield filter placement to prevent pulmonary embolus in patients with vena caval tumor thrombi. J Urol 1992; 147:19-23. [PMID: 1729531 DOI: 10.1016/s0022-5347(17)37122-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The presence of tumor thrombus secondary to inferior vena caval extension from renal carcinoma carries the threat of pulmonary tumor embolus. In theory, safe prophylaxis could be accomplished by placement of a Greenfield filter in the suprarenal vena cava, which has been accomplished without complication. We treated 6 patients with renal call carcinoma and extensive tumor thrombus of the vena cava with suprarenal filter placement as an adjunct to thrombectomy and nephrectomy. Clinically all 6 patients have done well. However, the over-all rate of vena caval thrombosis or occlusion associated with infrarenal filter placement is 3 to 5%. To investigate the potential risk to renal function if a vena caval occlusion occurred above a solitary kidney shortly after unilateral nephrectomy, we performed suprarenal inferior vena caval ligations after unilateral nephrectomy in 10 dogs. A total of 6 dogs suffered persistent loss of renal function and 3 of these 6 died of uremia. Of 4 dogs who underwent suprarenal inferior vena caval ligation only 1 (25%) had persistent compromise of renal function. A total of 2 dogs underwent unilateral nephrectomy only without compromise of normal renal function. We conclude that the risk of total vena caval occlusion after suprarenal Greenfield filter placement is small. However, should it occur in the setting of recent nephrectomy there is potential for significant renal morbidity. In selected patients this risk may be offset by the potential benefits that the filter offers in terms of protection against tumor and/or bland pulmonary embolus. Further clinical experience will be needed to strengthen and clarify the indications and benefits of preoperative or intraoperative filter placement as reported.
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Affiliation(s)
- D W Brenner
- Department of Urology, Eastern Virginia Medical School, Norfolk
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12
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Steib A, Jochum D, Freys G, Wolf P, Otteni JC. [Peroperative massive pulmonary embolism of tumoral origin. Value of extensive monitoring]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1991; 10:583-5. [PMID: 1785710 DOI: 10.1016/s0750-7658(05)80298-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A case is reported of a 47-year-old female patient who suffered from massive tumour embolism during a nephrectomy for a renal carcinoma invading the inferior vena cava. Intraoperative monitoring consisted in direct blood pressure measurement (radial artery cannula), central haemodynamic monitoring (Swan-Ganz catheter), pulse oximetry and capnography. During the surgical manipulation of the suprahepatic vena cava, Petco2 suddenly decreased (from 25 mmHg to 14 mmHg), together with Spo2 (from 99% to 89%), and the mean pulmonary arterial pressure increased from 18 mmHg to 40 mmHg. The drop in arterial blood pressure to 50/30 mmHg, initiated an immediate sternotomy. After clamping the superior and inferior venae cavae, numerous tumour fragments were removed from the pulmonary artery. Cardiac activity restarted after internal cardiac massage, 1 mg adrenaline, 1 g calcium chloride and 150 mmol of molar sodium bicarbonate. The whole procedure lasted 30 min. Arterial blood pressure became stable at 110/50 mmHg, pulmonary arterial and wedge pressures at 20 and 5 mmHg. The Spo2 increased to 98%, and Petco2 to 25 mmHg. The nephrectomy was then carried out, the patient being given 5 micrograms.kg-1.min-1 dobutamine and 3 micrograms.kg-1.min-1 dopamine. At the end of surgery, systolic blood pressure was 120 mmHg, mean pulmonary arterial pressure 25 mmHg, and PaCO2 34 mmHg. The patient left the intensive care unit after twelve days. After one year of follow-up, no complication had occurred. The value of cardiopulmonary bypass in nephrectomy for renal carcinoma invading the vena cava, or the renal vein, is discussed.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A Steib
- Service d'Anesthésie-Réanimation, Hôpital de Hautepierre, Strasbourg
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13
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Welch M, Bazaral MG, Schmidt R, Pontes JE, Cosgrove DM, Montie JE, Novick AC. Anesthetic management for surgical removal of renal carcinoma with caval or atrial tumor thrombus using deep hypothermic circulatory arrest. JOURNAL OF CARDIOTHORACIC ANESTHESIA 1989; 3:580-6. [PMID: 2520937 DOI: 10.1016/0888-6296(89)90156-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Twenty cases of renal carcinoma with tumor thrombus extending into the vena cava or atrium, in which cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) were used, are reviewed. Arterial, central venous (n = 9), or pulmonary artery catheters (n = 11), ECG, and rectal or bladder and pharyngeal temperatures were used for monitoring. The anesthetic was a high-dose narcotic supplemented with a nondepolarizing relaxant and a volatile agent. The surgery consisted of mobilization of the kidney followed by CPB via atrial and aortic cannulae, cooling via CPB, exsanguination, and removal of thrombus during DHCA. Duration of cooling was 21 +/- 7 minutes to a pharyngeal temperature of 15.8 degrees +/- 2.6 degrees C with alpha-stat pH management; DHCA lasted 26 +/- 10 minutes, and rewarming was continued to a mean pelvic temperature of 36.2 degrees C. Duration of surgery was 8.1 +/- 1.6 hours. The mean initial hematocrit was 33.5%, mean lowest Hct during CPB was 16.9%, and mean Hct at the end of surgery was 30%. Intraoperatively, 9.0 +/- 6.4 units of blood were used, and most patients received component therapy. Average crystalloid use was 7 L, and albumin or hetastarch (1.3 +/- 0.9 L) was used in 13 patients. One patient with severe cardiac disease could not be weaned from CPB. In the 19 operative survivors, there were no neurological deficits. There was one late death from pulmonary complications. The use of thiopental (n = 13), dexamethasone (n = 11), or mannitol (n = 19) was not clearly related to outcome. Hypothermia, hemodilution, alpha-stat pH management, and normoglycemia are believed to be important aspects of perioperative care.(ABSTRACT TRUNCATED AT 250 WORDS)
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anesthesia Recovery Period
- Anesthesia, General/adverse effects
- Anesthesia, General/methods
- Anesthesia, Inhalation/adverse effects
- Anesthesia, Inhalation/methods
- Anesthesia, Intravenous/adverse effects
- Anesthesia, Intravenous/methods
- Blood Loss, Surgical
- Carcinoma, Renal Cell/pathology
- Carcinoma, Renal Cell/surgery
- Cardiopulmonary Bypass/adverse effects
- Cardiopulmonary Bypass/methods
- Diaphragm/blood supply
- Erythrocyte Count
- Heart Arrest, Induced/adverse effects
- Heart Arrest, Induced/methods
- Heart Atria/pathology
- Heart Neoplasms/pathology
- Heart Neoplasms/surgery
- Hepatic Veins/pathology
- Humans
- Hypothermia, Induced/adverse effects
- Hypothermia, Induced/methods
- Kidney Neoplasms/surgery
- Middle Aged
- Neoplastic Cells, Circulating/pathology
- Respiratory Insufficiency/etiology
- Time Factors
- Vena Cava, Inferior/pathology
- Vena Cava, Inferior/surgery
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Affiliation(s)
- M Welch
- Department of Cardio-Thoracic Anesthesiology, Cleveland Clinic Foundation, OH 44106
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14
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Skinner DG, Pritchett TR, Lieskovsky G, Boyd SD, Stiles QR. Vena caval involvement by renal cell carcinoma. Surgical resection provides meaningful long-term survival. Ann Surg 1989; 210:387-92; discussion 392-4. [PMID: 2774709 PMCID: PMC1358008 DOI: 10.1097/00000658-198909000-00014] [Citation(s) in RCA: 265] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In 1972 we first reported that vena caval extension by tumor thrombus was a potentially curable lesion provided that complete removal could be achieved. We have developed a technique for safe removal of extensive vena caval thrombi extending up to the right atrium without the need for cardiopulmonary bypass or hypothermic cardioplegia. Cardiopulmonary bypass, however, is advocated for some type III thrombi, but the addition of the pump and heparinization compounds the magnitude of the procedure. We use a right thoracoabdominal approach for tumors arising from either kidney with vascular isolation of the vena cava from its insertion into the right atrium to the iliac bifurcation. From 1972 to 1988, 56 patients ranging in age from 31 to 76 years were evaluated and 53 underwent radical nephrectomy with en bloc vena caval tumor thrombectomy. Of these patients, 21 had subhepatic caval thrombus extension (level 1); 24 had extension into the intrahepatic vena cava (level 2), and 8 had thrombi extending into the heart (level 3). Overall 1-, 3-, and 5-year survival was 56%, 34%, and 25%, respectively. Crucial to survival was complete surgical excision. Successful extirpation of all apparent tumor was possible in 75% of the patients in this series. With an expected 5-year survival rate of 57% for those without metastatic disease to other organs, we continue to advocate an aggressive optimistic approach for patients if there is no preoperative evidence of metastatic disease.
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Affiliation(s)
- D G Skinner
- University of Southern California Medical Center, Department of Urology, Los Angeles 90033
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15
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Frego E, Cozzoli A, Pardini A, Cosciani-Cunico S. Neoplasia Renale Con Trombosi Cavo-Atriale: Nefrectomia Allargata in C.E.C. E Ipotermia. Urologia 1989. [DOI: 10.1177/039156038905600320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Attwood S, Lang DM, Goiti J, Grant J. Venous bypass for surgical resection of renal carcinoma invading the vena cava: a new approach. BRITISH JOURNAL OF UROLOGY 1988; 61:402-5. [PMID: 3395798 DOI: 10.1111/j.1464-410x.1988.tb06584.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A new technique is described which facilitates the surgical removal of renal carcinoma from the inferior vena cava. The use of cardiopulmonary bypass with or without cardiac arrest has been advocated but with this procedure only the inferior vena cava is bypassed, using femoral and right atrial cannulation, assisted by a closed system electromagnetic centrifugal pump. In appropriate cases this less complex technique allows prolonged access to the inferior vena cava whilst providing equal protection from pulmonary embolisation and tumour dissemination; it also reduces morbidity, operating time, difficulty and cost when compared with cardiopulmonary bypass.
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Affiliation(s)
- S Attwood
- Department of Urology, Northern General Hospital, Sheffield
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17
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O'Donohoe MK, Flanagan F, Fitzpatrick JM, Smith JM. Surgical approach to inferior vena caval extension of renal carcinoma. BRITISH JOURNAL OF UROLOGY 1987; 60:492-6. [PMID: 3427330 DOI: 10.1111/j.1464-410x.1987.tb05027.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Between 1979 and 1985, 10 patients were treated for renal carcinoma with extension into the inferior vena cava but without evidence of disseminated disease. Two of these had tumour thrombus extension up to the level of the hepatic veins and in four the extension was above the level of the diaphragm, two of which entered the atrium. Thrombus was removed en bloc at radical nephrectomy. Six patients are still alive, with a mean survival of 22 months. There was no correlation between the level of tumour thrombus and perinephric extension or indeed any correlation between tumour thrombus level and overall survival. It is suggested that tumour thrombus in the inferior vena cava, in the absence of metastatic disease, should be managed by radical surgery.
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Affiliation(s)
- M K O'Donohoe
- Department of Urology, Mater Misericordiae Hospital, Dublin, Irish Republic
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18
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Hugh TB, Jones RM, Shanahan MX. Intra-atrial extension of renal and adrenal tumors: diagnosis, management, and prognosis. World J Surg 1986; 10:488-95. [PMID: 3727610 DOI: 10.1007/bf01655317] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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19
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Muraguchi T, Sakai K, Yamada T, Usui N, Tsukamoto Y, Kimura E, Esaki K, Ikemoto S. Surgical management of renal cell carcinoma with inferior vena caval and right atrial involvement. THE JAPANESE JOURNAL OF SURGERY 1985; 15:399-404. [PMID: 4079145 DOI: 10.1007/bf02469937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A 52-year old man underwent successful surgical removal of renal cell carcinoma with inferior vena caval and right atrial involvement, under cardio-pulmonary bypass. The postoperative progress was uneventful and at this writing he is doing well, with no evidence of metastasis.
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20
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The Thoracic Cavity, A Troublesome Neighbor. Urol Clin North Am 1985. [DOI: 10.1016/s0094-0143(21)01669-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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21
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22
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Andréen T, Aberg T, Fritjofsson A. Surgery of renal cancer with extensive caval invasion. Suggestion for a new approach. Ups J Med Sci 1985; 90:107-14. [PMID: 3909590 DOI: 10.3109/03009738509178646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Radical surgery for renal cancer with invasion of the inferior vena cava can improve the patient's quality of life and, in some cases, offer longer survival or even cure. With a carefully planned surgical approach it is possible to remove renal tumours with thrombotic extension to the most proximal part of the inferior vena cava without necessity for cardiopulmonary bypass and without undue risk to the patient. In the operative procedure, good access and visual control of the proximal vena cava and all the contributing veins seem to be crucially important.
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