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Filizzola R, Romero D, Mendez S, Brunstein D, Benitez A. Results of Radical Nephrectomy and Inferior Vena Cava Thrombectomy. Curr Urol Rep 2024; 25:339-342. [PMID: 39138814 DOI: 10.1007/s11934-024-01228-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE OF REVIEW Renal Cell Carcinoma (RCC) with invasion into the inferior vena cava (IVC) is a rare and mortal condition. Patients with RCC have an average life expectancy of no more than six months, thus requiring an aggressive surgical approach. We analyze the outcomes of patients that underwent surgery at a single medical institution. RECENT FINDINGS The analysis of recent series of successful treatment with radical nephrectomy and IVC thrombectomy shows a 5 year survival from 45 to 69%. We found in the analyzed series that the success of the treatment in these patients depends on the resection of the renal tumor and venous thrombectomy. We found that at our medical institution nephrectomy and IVC thrombectomy with primary repair have no intraoperative mortality and no pulmonary embolism. Nephrectomy and thrombectomy of IVC is a reliable approach for patients with advance RCC.
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Affiliation(s)
- Roberto Filizzola
- Department of Vascular Surgery, Hospital Central Instituto de Prevision Social, Asunción, 001519, Paraguay.
| | - Daniel Romero
- Department of Urology, Hospital Central Instituto de Previsión Social, Asunción, 001519, Paraguay
| | - Samuel Mendez
- Department of Urology, Hospital Central Instituto de Previsión Social, Asunción, 001519, Paraguay
| | - David Brunstein
- Department of Vascular Surgery, Hospital Central Instituto de Prevision Social, Asunción, 001519, Paraguay
| | - Alejandro Benitez
- Department of Vascular Surgery, Hospital Central Instituto de Prevision Social, Asunción, 001519, Paraguay
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Xu J, Lee W, Yang S, Gao S, Ye Y, Deng G, Zhang W, Di J. Bibliometric analysis of renal cell carcinoma with venous tumor thrombus. Int J Med Sci 2024; 21:2094-2108. [PMID: 39239550 PMCID: PMC11373542 DOI: 10.7150/ijms.98359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 07/09/2024] [Indexed: 09/07/2024] Open
Abstract
Objectives: To identify the cooperation of authors, countries, institutions and explore the hot spots regarding research of renal cell carcinoma with venous tumor thrombus. Methods: Relevant articles were obtained from the Web of Science Core database (WoSC) from 1999 to 2024. CiteSpace was used to perform the analysis and visualization of scientific productivity and emerging trends. Network maps were generated to evaluate the collaborations between different authors, countries, institutions, and keywords. Results: A total of 2180 related articles were identified. We observed an increased enthusiasm in related fields during the past two decades. The USA dominated the field in all countries, and the University of Miami was the core institution. Ciancio G might have a significant influence with more publications and co-citations. Current research hotspots in this field mainly included thrombectomy, tyrosine kinase inhibitors, immune checkpoint inhibitors, vena cava inferior, and microvascular invasion. Thrombectomy complications, thrombectomy survival outcome, and preoperative neoadjuvant immunotherapy represented the frontiers of research in this field, undergoing an explosive phase. Conclusion: This is the first bibliometric study that comprehensively visualize the research trends and status of RCC with VTT. We hope that this work will provide new ideas for advancing the scientific research and clinical application.
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Affiliation(s)
- Jinbin Xu
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Weijen Lee
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shoudong Yang
- Department of Urology, Chashan Hospital of Dongguan, Dongguan, Guangdong, China
| | - Shuntian Gao
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuedian Ye
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Gengguo Deng
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Weixing Zhang
- Department of Urology, Chashan Hospital of Dongguan, Dongguan, Guangdong, China
| | - Jinming Di
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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Mata M, Tabbara MM, Alvarez A, González J, Ciancio G. Renal cell carcinoma with an "uncoiling" tumor thrombus: intraoperative shift from level III to level IV. World J Surg Oncol 2024; 22:76. [PMID: 38454471 PMCID: PMC10918875 DOI: 10.1186/s12957-024-03355-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The gold standard treatment for renal cell carcinoma (RCC) with tumor thrombus (TT) is complete surgical excision. The surgery is complex and challenging to the surgeon, especially with large tumor thrombus extending into the inferior vena cava (IVC) and right atrium. Traditionally, these difficult cases required the use of cardiopulmonary bypass (CPB) with or without deep hypothermic cardiac arrest, but in recent years, different surgical techniques derived from the field of liver transplantation have been used in efforts to avoid CPB. CASE PRESENTATION We present a case of RCC with TT level IIIc (extending above major hepatic veins) that "uncoiled" intraoperatively into the right atrium after division of the IVC ligament, transforming into a level IV TT. Despite the new TT extension, the surgery was successfully completed exclusively through an abdominal approach without CPB and while using intraoperative transesophageal echocardiography (TEE) monitoring and a cardiothoracic team standby. CONCLUSIONS This case highlights the need for a multidisciplinary approach and the utility of intraoperative continous TEE monitoring which helped to visualize the change of the TT venous extension, allowing the surgical teamto modify their surgical approach as needed avoiding a catastrophic event.
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Affiliation(s)
- Marina Mata
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
- Unidad de Cirugia Renal, Trasplante e Investigación, Hospital Ramón y Cajal, Madrid, Spain
| | - Marina M Tabbara
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Angel Alvarez
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Javier González
- Servicio de Urología, Unidad de Trasplante Renal, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gaetano Ciancio
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.
- Department of Surgery and Urology, University of Miami Miller School of Medicine, 1801 NW 9th Ave, 7th Floor, Miami, FL, 33136, USA.
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Chen R, Mei Z, Chen J. Scrutinizing VTE risk factors in complex renal tumor patients: a comprehensive look at the VTE-RT-IVCTT study. Int J Surg 2024; 110:1813-1814. [PMID: 38051929 PMCID: PMC10942190 DOI: 10.1097/js9.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Ru Chen
- Department of Urology, Fujian Medical University Union Hospital, Gulou District, Fuzhou City, Fujian Province
| | - Zubing Mei
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine
- Anorectal Disease Institute of Shuguang Hospital, Shanghai, People’s Republic of China
| | - Jianhui Chen
- Department of Urology, Fujian Medical University Union Hospital, Gulou District, Fuzhou City, Fujian Province
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Taweemonkongsap T, Suk-Ouichai C, Jitpraphai S, Woranisarakul V, Hansomwong T, Chotikawanich E. Survival benefits after radical nephrectomy and IVC thrombectomy of renal cell carcinoma patients with inferior vena cava thrombus. Heliyon 2024; 10:e25835. [PMID: 38390094 PMCID: PMC10881333 DOI: 10.1016/j.heliyon.2024.e25835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/15/2023] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Objective The role of tumor thrombus as a predictor of survival in patients with renal cell carcinoma (RCC) is controversial. This study aims to evaluate surgical and oncological outcomes after surgery in RCC with inferior vena cava (IVC) tumor thrombus patients. Materials and methods A total of 58 patients (2002-2019) underwent radical nephrectomy and IVC thrombectomy at our institute, were retrospectively reviewed. Kaplan-Meier analysis was utilized to compare survival benefits between cohorts and Cox-regression to evaluate potential predictors of patient survival. Results There were 5(8.6%), 21(36.2%), 23(39.7%) and 9 (15.5%) patients with tumor thrombus level I, II, III and IV respectively. The major complications (Clavien 3-5) were observed in 15 patients (25.8%) and 12 patients (80%) were patients with high thrombus level (III-IV). There was 9%mortality (5patients): 2 intraoperatively and 3 postoperatively. Median follow-up was 15 months (IQR:5-41). Two-year overall survival (OS) was 80% and 75% in all patients and pN0M0 cohort, respectively. There was significant difference in OS among each IVC thrombus level cohort (p < 0.02). Two-year OS of metastatic RCC patients was 67% and not significantly different when compared to non-metastatic cohort (p = 0.12). On multivariate analysis, only sarcomatoid dedifferentiation was associated with OS(p = 0.04). Disease-free survival was not significantly different among thrombus-level cohorts (p = 0.65). Conclusions Our study suggested that surgical treatment for RCC with IVC thrombus provided substantial OS outcomes. Although survival was significantly reduced with higher IVC thrombus level cohort, the level of thrombus itself was not an independent factor. Only sarcomatoid dedifferentiation was a predictor for reduced OS after radical nephrectomy and tumor thrombectomy. Meticulous patient selection and prompt counselling are substantial step for the operation.
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Affiliation(s)
- Tawatchai Taweemonkongsap
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalairat Suk-Ouichai
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Siros Jitpraphai
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Varat Woranisarakul
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thitipat Hansomwong
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekkarin Chotikawanich
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Shah MS, Wang KR, Shah YB, Ragam R, Simhal RK, Ghodoussipour S, Djaladat H, Mark JR, Lallas CD, Chandrasekar T. A Narrative Review on Robotic Surgery as Treatment for Renal Cell Carcinoma with Inferior Vena Cava Thrombus. J Clin Med 2024; 13:1308. [PMID: 38592152 PMCID: PMC10932232 DOI: 10.3390/jcm13051308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Renal cell carcinoma (RCC) is a common diagnosis, of which a notable portion of patients present with an extension into the venous circulation causing an inferior vena cava (IVC) tumor thrombus. Venous extension has significant implications for staging and subsequent treatment planning, with recommendations for more aggressive surgical removal, although associated surgical morbidity and mortality is relatively increased. The methods for surgical removal of RCC with IVC thrombus remain complex, particularly surrounding the use of robot-assisted surgery. Robot assistance for radical nephrectomy in this context is recently emerging. Thrombus level has important implications for surgical technique and prognosis. Other preoperative considerations may include location, laterality, size, and wall invasion. The urology literature on treatment of such tumors is largely limited to case series and institutional studies that describe the feasibility of various surgical options for these complex tumors. Further understanding of the outcomes and patient-specific risk factors would shed increased light on the optimal treatment for such cases. This narrative review provides a thorough overview on the previously reported use of robot-assisted nephrectomy in RCC with IVC thrombus to inform further studies which may optimize outcomes and guide shared decision-making.
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Affiliation(s)
- Mihir S. Shah
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | - Kerith R. Wang
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | - Yash B. Shah
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | - Radhika Ragam
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | | | - Saum Ghodoussipour
- Division of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Houman Djaladat
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - James R. Mark
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | - Costas D. Lallas
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
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Hatzakorzian R, Blotsky A, Moore A, Vaillancourt J, Mettasittigorn P, Aprikian A, Backman SB. Migration of an Inferior Vena Cava Tumor Thrombus during Renal Cell Carcinoma Resection. Case Rep Anesthesiol 2023; 2023:6632030. [PMID: 38170091 PMCID: PMC10761220 DOI: 10.1155/2023/6632030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/21/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
Approximately 4%-10% of patients with renal cell carcinoma (RCC) have tumoral vascular invasion with resultant thrombi in the renal vein and in the inferior vena cava (IVC). The authors describe an interesting case of IVC tumor thrombus that migrated to the right cardiac chambers during RCC resection. The diagnosis was made by intraoperative transesophageal echocardiography (TEE), which revealed the presence of a free-floating thrombus between the right atrium (RA) and right ventricle (RV). The patient required an urgent sternotomy with cardiopulmonary bypass (CPB) for atrial thrombus removal prior to the completion of the nephrectomy. The patient made a full recovery and was discharged to a rehabilitation facility. These findings illustrate the importance of intraoperative TEE monitoring during nephrectomy and IVC thrombectomy. In this case, TEE allowed for the diagnosis of an unexpected complication necessitating prompt cardiac surgical management.
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Affiliation(s)
- Roupen Hatzakorzian
- Department of Anesthesia, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
- Department of Critical Care, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
| | - Andrea Blotsky
- Department of Critical Care, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
- Department of General Internal Medicine, McGill University, St-Mary's Hospital, 3830 Lacombe Avenue, Montréal H3T 1M5, Québec, Canada
| | - Albert Moore
- Department of Anesthesia, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
| | - Julien Vaillancourt
- Department of Anesthesia, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
| | - Pattra Mettasittigorn
- Department of Anesthesia, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
| | - Armen Aprikian
- Department of Urology, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
| | - Steven B. Backman
- Department of Anesthesia, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
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Gwon JG, Cho YP, Han Y, Suh J, Min SK. Technical Tips for Performing Suprahepatic Vena Cava Tumor Thrombectomy in Renal Cell Carcinoma without Using Cardiopulmonary Bypass. Vasc Specialist Int 2023; 39:23. [PMID: 37667821 PMCID: PMC10480049 DOI: 10.5758/vsi.230056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/27/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023] Open
Abstract
Radical nephrectomy with tumor thrombectomy for advanced renal cell carcinoma is an oncologically relevant approach that can achieve long-term survival even in the presence of distant metastases. However, the surgical techniques pose significant challenges. The objective of this clinical review was to present technical recommendations for tumor thrombectomy in the vena cava to facilitate surgical treatment. Transesophageal echocardiography is required to prepare for this procedure. Cardiopulmonary bypass should be considered when the tumor thrombus has invaded the cardiac chamber and clamping is not feasible because of the inability to milk the intracardiac chamber thrombus in the caudal direction. Prior to performing a cavotomy, it is crucial to clamp the contralateral renal vein and infrarenal and suprahepatic inferior vena cava (IVC). If the suprahepatic IVC is separated from the surrounding tissue, it can be gently pulled down toward the patient's leg until the lower margin of the atrium becomes visible. Subsequently, the tumor thrombus should be carefully pulled downward to a position where it can be clamped. Implementing the Pringle maneuver to reduce blood flow from the hepatic veins to the IVC during IVC cavotomy is simpler than clamping the hepatic veins. Sequential clamping is a two-stage method of dividing thrombectomy by clamping the IVC twice, first suprahepatically and then midretrohepatically. This sequential clamping technique helps minimize hypotension status and the Pringle maneuver time compared to single clamping. Additionally, a spiral cavotomy can decrease the degree of primary closure narrowing. The oncological prognoses of patients can be improved by incorporating these technical recommendations.
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Affiliation(s)
- Jun Gyo Gwon
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Pil Cho
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Youngjin Han
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Jungyo Suh
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Kee Min
- Division of Vascular Surgery, Department of Surgery, Seoul National University Hospital, Seoul, Korea
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Brimo Alsaman MZ, Almerhej M, Qut A, Al Nahhas Z, Alia L, Nahas MA. A rare co-occurrence of renal cell carcinoma, bilateral adrenal metastasis and inferior vena cava thrombus: A case report. Int J Surg Case Rep 2023; 110:108675. [PMID: 37611394 PMCID: PMC10470296 DOI: 10.1016/j.ijscr.2023.108675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION The incidence of ipsilateral adrenal metastasis from RCC varies between 1.1 and 10 %, on the other hand, the presence of bilateral adrenal metastasis from solitary RCC is extremely rare, with less than 20 reported cases in the literature. CASE PRESENTATION A 68-year-old man presented to the clinic with hematuria. Further investigations, contrast CT, showed mass at the right kidney and adrenal gland, a mass on the left adrenal gland and inferior cava thrombosis measuring 3*6 cm. The patient underwent, first, right nephrectomy and adrenalectomy with thrombectomy and IVC plasty. Microscopic examination showed clear cell renal cell carcinoma, while adrenal tissue showed metastatic renal cell carcinoma. The patient was followed up from the oncological, endocrinological and cardiac point of view. After 6 months he underwent left adrenalectomy. Subsequent follow-up showed body free of metastases. CLINICAL DISCUSSION The co-occurrence of renal cell carcinoma, bilateral adrenal metastasis, and inferior vena cava thrombus is a very rare phenomenon in the literature. Most patients with adrenal metastasis are asymptomatic, and the adrenal function is typically preserved even when malignancy affects bilateral adrenal glands. In addition, patients with adrenal ipsilateral metastases typically have primary renal tumors with poor prognosis. CONCLUSION The Diagnosis and management are a surgical challenge. Contrast-enhanced CT scan is the preferred imaging modality for renal cell carcinoma. The surgical intervention is mandatory if it can increase survival rate.
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Affiliation(s)
| | - Merhej Almerhej
- Vascular and Endovascular Surgery Department, Al-Assad University Hospital, Damascus University, Damascus, Syria
| | - Alaa Qut
- Vascular and Endovascular Surgery Department, Al-Assad University Hospital, Damascus University, Damascus, Syria
| | | | - Louei Alia
- Urology Department, Al-Assad University Hospital, Damascus University, Damascus, Syria
| | - Mohamad Ali Nahas
- Vascular and Endovascular Surgery Department, Al-Assad University Hospital, Damascus University, Damascus, Syria.
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Zacek P, Brodak M, Gofus J, Dominik J, Moravek P, Louda M, Podhola M, Vojacek J. Renal cell carcinoma with intracardiac tumor thrombus extension: Radical surgery yields 2 years of postoperative survival in a single-center study over a period of 30 years. Front Oncol 2023; 13:1137804. [PMID: 36816971 PMCID: PMC9931241 DOI: 10.3389/fonc.2023.1137804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
Background Renal cell carcinoma (RCC) with tumor thrombus extension into the right atrium (level IV) is a rare life-threatening clinical condition that can only be managed by means of a combined urological and cardiac surgical approach. The early and late outcomes of this radical treatment were analyzed in a large single-institution series over a period of 30 years. Methods In 37 patients with RCC and intracardiac tumor thrombus extension, nephrectomy was performed followed by the extraction of the intracaval and intracardiac tumor thrombus under direct visual control during deep hypothermic circulatory arrest (DHCA). Recently, in 13 patients, selective aortic arch perfusion (SAAP) was instituted during DHCA. Results In all patients, precise removal of the tumor thrombus was accomplished in a bloodless field. The mean duration of isolated DHCA was 15 ± 6 min, and 31.5 ± 10.2 min in the case of DHCA + SAAP, at a mean hypothermia of 22.7 ± 4°C. In-hospital mortality was 7.9% (3 patients). In Kaplan-Meier analysis, the estimated median survival was 26.4 months whereas the 5-year cancer-related survival rate was 51%. Conclusions Despite its complexity, this extensive procedure can be performed safely with a generally uneventful postoperative course. The use of cardiopulmonary bypass with DHCA, with the advantage of SAAP, allows for a safe, precise, and complete extirpation of intracaval and intracardiac tumor mass. Late outcomes after radical surgical treatment in patients with RCC and tumor thrombus reaching up in the right atrium in our series justify this extensive procedure.
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Affiliation(s)
- Pavel Zacek
- Department of Cardiac Surgery, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec, Kralove, Czechia
| | - Milos Brodak
- Department of Urology, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec, Kralove, Czechia
| | - Jan Gofus
- Department of Cardiac Surgery, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec, Kralove, Czechia,*Correspondence: Jan Gofus,
| | - Jan Dominik
- Department of Cardiac Surgery, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec, Kralove, Czechia
| | - Petr Moravek
- Department of Urology, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec, Kralove, Czechia
| | - Miroslav Louda
- Department of Urology, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec, Kralove, Czechia
| | - Miroslav Podhola
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec, Kralove, Czechia
| | - Jan Vojacek
- Department of Cardiac Surgery, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec, Kralove, Czechia
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Tabbara MM, González J, Martucci M, Ciancio G. Current Approaches in Surgical and Immunotherapy-Based Management of Renal Cell Carcinoma with Tumor Thrombus. Biomedicines 2023; 11:204. [PMID: 36672712 PMCID: PMC9855836 DOI: 10.3390/biomedicines11010204] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Renal cell carcinoma (RCC) accounts for 2-3% of all malignant disease in adults, with 30% of RCC diagnosed at locally advanced or metastatic stages of disease. A form of locally advanced disease is the tumor thrombus (TT), which commonly grows from the intrarenal veins, through the main renal vein, and up the inferior vena cava (IVC), and rarely, into the right cardiac chambers. Advances in all areas of medicine have allowed increased understanding of the underlying biology of these tumors and improved preoperative staging. Although the development of several novel system agents, including several clinical trials utilizing immune checkpoint inhibitors and combination therapies, has been shown to lower perioperative morbidity and increase post-operative recurrence-free and progression-free survival, surgery remains the mainstay of therapy to achieve a cure. In this review, we provide a description of specific surgical approaches and techniques used to minimize intra- and post-operative complications during radical nephrectomy and tumor thrombectomy of RCC with TT extension of various levels. Additionally, we provide an in-depth review of the major developments in neoadjuvant and adjuvant immunotherapy-based treatment and the impact of ongoing and recently completed clinical trials on the surgical treatment of advanced RCC.
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Affiliation(s)
- Marina M. Tabbara
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA
| | - Javier González
- Servicio de Urología, Unidad de Transplante Renal, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Melanie Martucci
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA
| | - Gaetano Ciancio
- Department of Surgery and Urology, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA
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Tabbara MM, González J, Ciancio G. Renal Cell Carcinoma with Supradiaphragmatic Tumor Thrombus: Avoiding Sternotomy and Cardiopulmonary Bypass. MEDICAL RESEARCH ARCHIVES 2022; 10:10.18103/mra.v10i7.2913. [PMID: 36714035 PMCID: PMC9879345 DOI: 10.18103/mra.v10i7.2913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Renal cell carcinoma (RCC) accounts for 2-3% of all malignant disease in adults and has a propensity to infiltrate the surrounding adjacent structures with a biologic predisposition for vascular invasion. This tropism for the venous system facilitates propagation into the renal vein and inferior vena cava (IVC) in up to 25% of patients with RCC. Surgical resection remains the mainstay treatment for RCC with venous tumor thrombus (TT) extension and the only hope for a potential cure. Higher thrombus levels correlate with more advanced stages of disease and thus poorer survival rates. Although CPB with circulatory arrest has been successfully performed during resection of these tumors, its use remains controversial due to the risk of coagulopathy, platelet dysfunction, and central nervous system complications. Complete intraabdominal surgical excision of level III thrombi can be achieved without sternotomy and CPB by utilizing hepatic mobilization maneuvers. The purpose of this review is to provide an update on the surgical management of these difficult cases of RCC with supradiaphragmatic tumor thrombi, including a description of transplant-based techniques that avoid sternotomy and cardiopulmonary bypass (CPB), minimizing intra- and post-operative complications.
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Affiliation(s)
- Marina M. Tabbara
- Department of Surgery, University of Miami Miller School of Medicine; Miami, Florida,Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital; Miami, Florida
| | - Javier González
- Servicio de Urología, Unidad de Trasplante Renal, Hospital General Universitario Gregorio Marañón; Madrid, Spain
| | - Gaetano Ciancio
- Department of Surgery, University of Miami Miller School of Medicine; Miami, Florida,Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital; Miami, Florida,Department of Urology, University of Miami Miller School of Medicine; Miami, Florida,
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Bhat A, Kava B. Large left moiety renal tumor with renal vein thrombus in a horseshoe kidney. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00287-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Management of large renal tumors in a horseshoe kidney has received little attention due to the highly infrequent occurrence. Surgical management for tumors in horseshoe kidney is challenging due to complex aberrant vascular anatomy, relative fixity of the renal moieties and other associated conditions such as ectopia and malrotation. An added component of a renal vein thrombus in this scenario often adds to the surgical conundrum. Inadequate peri-operative management may cause devastating complications and increased morbidity and mortality. Careful pre-operative planning and meticulous intra-operative dissection limits blood loss and thereby complications.
Case presentation
We present the peri-operative management of a large renal tumor with a renal vein thrombus in a horseshoe kidney moiety as a case report with literature review focusing on the intra-operative surgical approach that may be adopted for these tumors. A 12 cm × 10 cm left renal moiety mass with renal vein thrombus with no distant metastasis was diagnosed. After confirmation of thrombus extent with CT as well as MRI Abdomen, the patient underwent left moiety radical nephrectomy with renal vein thrombectomy. Careful intra-operative dissection and division of the vascular supply of the left renal moiety was performed. Vessel stapler was used for division of isthmus that resulted in minimal blood loss, complete oncologic clearance and minimal post operative morbidity.
Conclusions
Large renal tumor with renal vein thrombus in horseshoe kidneys is an uncommon condition. Pre operative cross-sectional imaging and intra-operative use of vessel sealants like Ligasure, harmonic scalpel and vessel staplers contribute to minimizing blood loss and thereby result in excellent patient outcomes. We report a case of a large left renal moiety tumor with renal vein thrombus successfully managed with open radical left moiety nephrectomy and isthmectomy with tumor thrombectomy.
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Tabbara MM, Farag A, Ciancio G. Renal cell carcinoma with inferior vena cava tumor thrombus initially misdiagnosed as bland thrombus due to hypercoagulable state. SAGE Open Med Case Rep 2022; 10:2050313X221102019. [PMID: 35619748 PMCID: PMC9128047 DOI: 10.1177/2050313x221102019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/29/2022] [Indexed: 11/26/2022] Open
Abstract
Renal cell carcinoma with inferior vena cava tumor thrombus can be misdiagnosed as an inferior vena cava thrombosis if not evaluated carefully with imaging. We describe a case of renal cell carcinoma with inferior vena cava tumor thrombus that was initially misdiagnosed as an inferior vena cava thrombosis due to a possible hypercoagulable state. After 7 months of anticoagulation therapy with no improvement, a right radical nephrectomy and thrombectomy was performed without cardiopulmonary bypass, and a diagnosis of papillary renal cell carcinoma with a level-IIId tumor thrombus was confirmed with no presence of a bland thrombus. We demonstrate the complexity of identifying and treating renal cell carcinoma with venous tumor thrombus and the importance of differentiating between a malignant thrombus and a bland thrombus.
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Affiliation(s)
- Marina M. Tabbara
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
- Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, FL, USA
| | - Ahmed Farag
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
- Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, FL, USA
- Department of Surgery, School of Medicine, Zagazig University, Zagazig, Egypt
| | - Gaetano Ciancio
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
- Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, FL, USA
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
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15
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Liu L, Tang S, Liu Z, Liu C, Zhang H, Tian X, Wang G, Zhang S, Ma L. Robot-Assisted Laparoscopic IVC Treatment Strategy in Retroperitoneal Tumors. Front Oncol 2022; 12:908272. [PMID: 35669432 PMCID: PMC9166303 DOI: 10.3389/fonc.2022.908272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives To show the practice of robot-assisted laparoscopic inferior vena cava (IVC) treatment strategies in patients with retroperitoneal tumors. Patients and Methods From October 2020 to July 2021, 17 patients with retroperitoneal tumors successfully underwent robot-assisted laparoscopic tumor resection with IVC management. The patient details, tumor characteristics, intraoperative data, pathological features and severe complications were assessed. The IVC treatment strategies were divided into 4 ways: ①local resection and primary repair of the IVC; ②IVC ligation; ③ IVC reconstruction by bovine pericardial grafts; and ④ IVC transection and anastomosis. Results In terms of IVC management, 5 cases had conventional total occlusion of the IVC and its branches, 3 cases had delayed occlusion of the proximal IVC technique, 2 cases had IVC resection by Satinsky clamp, 5 cases had IVC ligation, 1 case had IVC reconstruction by bovine pericardial grafts and 1 case had IVC transection and anastomosis. The median operation time was 151 min, and blood loss was 500 ml. There was no severe complication perioperatively. The follow-up time of 17 patients was 8 to 17 months (median: 12 months). No local recurrence or overall death was found during follow-up. Conclusions These robot-assisted laparoscopic IVC treatment strategies were considered to be safe and feasible in experienced centers, as well as helpful to completely remove the tumor for better oncological prognosis and restore the blood reflux of IVC as much as possible to ensure fewer postoperative complications.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, China
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16
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Liu Y, Liu Z, Peng R, Xiao R, Wang J, Wang H, Ma L. Preoperative stereotactic body radiotherapy combined with surgical treatment for renal cell carcinoma and inferior vena cava tumour thrombus: study protocol for a single-arm cohort trial. BMJ Open 2022; 12:e055364. [PMID: 35105644 PMCID: PMC8804625 DOI: 10.1136/bmjopen-2021-055364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Although surgery is currently the first choice for patients with renal cell carcinoma and vena cava tumour thrombus, the surgery is difficult, with many complications, and the prognosis of patients is not ideal. Renal cell carcinoma is not sensitive to traditional radiotherapy, but the development of stereotactic ablative body radiotherapy (SABR) technology with the characteristics of high precision, dose and conformity has made the radiotherapy of renal cell carcinoma reexamined. METHODS AND ANALYSIS STUDY DESIGN: This trial is a single-arm cohort study sponsored by Peking University Third Hospital. STUDY TREATMENT Preoperative stereotactic ablative radiotherapy combined with surgical treatment. PRIMARY ENDPOINTS: (1) Adverse reactions after 4-6 weeks of SABR. (2) Mayo staging of tumour thrombus. (3) The length of the tumour thrombus from the corresponding anatomical mark. (4) Invasion of the inferior vena cava wall. (5) Recurrent-free survival rate of the tumour. (6) Cancer-specific survival rate. (7) Overall survival rate. (8) Perioperative indicators including operation time, intraoperative bleeding volume and postoperative complications. SECONDARY ENDPOINTS: (1) The longest diameter of the tumour and (2) Lymph node condition. MAIN INCLUSION CRITERIA Patients with renal cell carcinoma and inferior vena cava tumour thrombus graded from Mayo II to IV and eligible for radical nephrectomy and inferior vena cava thrombectomy. MAIN EXCLUSION CRITERIA Patients with previous targeted therapy, chemotherapy or other interventions, or who cannot tolerate SABR or surgery. PLANNED SAMPLE SIZE 20 patients. ETHICS AND DISSEMINATION The trial protocol and the informed consent of the subjects were submitted and approved by the Peking University Biomedical Ethics Committee. TRIAL REGISTRATION NUMBER ChiCTR1800015118.
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Affiliation(s)
- Yunchong Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Ran Peng
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Ruotao Xiao
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Hao Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
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Hypofractionated radiotherapy for renal cell carcinoma with inferior vena cava tumour thrombus. Contemp Oncol (Pozn) 2022; 26:310-313. [PMID: 36816397 PMCID: PMC9933356 DOI: 10.5114/wo.2023.124792] [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: 08/14/2022] [Accepted: 11/27/2022] [Indexed: 02/12/2023] Open
Abstract
Renal cell carcinoma (RCC) constitutes about 3% of all malignant neoplasms in adults. Clear cell carcinoma is the most frequent type, accounting for about 65% of cases. It tends to invade the veins and form tumour thrombi in inferior vena cava (IVC-TT), occasionally reaching the right atrium. Nephrectomy and thrombectomy are standard therapeutic procedures performed in RCC-IVC-TT. Despite proven effectiveness of surgery, this entity in IVC-TT is associated with poor outcome. The role of palliative radiotherapy in this entity is undetermined. We present a case of a 43-year-old female patient after right-sided nephrectomy due to advanced RCC which invaded the IVC, hepatic veins, and right atrium. The patient has been treated with postoperative, hypofractionated radiotherapy on the residual disease.
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Thangarasu M, Prakash JS, Bafna S, Aarthy P, Govindaswamy TG, Venugopal B, Sivaraman A, Jain N, Balakrishnan A, Raghavan D, Venkatraman M, Chandranathan M, Paul R, Selvaraj N, Ramakrishnan B, Ragavan N. Influence of tumor size in the progression of venous tumor thrombus in renal cell carcinoma: A 7-year single-center experience. Urol Ann 2022; 14:273-278. [PMID: 36117789 PMCID: PMC9472312 DOI: 10.4103/ua.ua_169_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/26/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The objective of the study is to describe the perioperative outcomes, disease-specific, and overall survival status in patients diagnosed with renal cell carcinoma with inferior vena cava (IVC) tumor thrombus. PATIENTS AND METHODS We did a retrospective analysis of all patients who underwent radical nephrectomy along with IVC thrombectomy from the year 2013 to 2020. Mayo's classification was used to stratify the level of IVC thrombus. Demographic, perioperative, histopathology data, complications, and survival status were analyzed. RESULTS Total number of patients included in the study was 39, (Male: Female = 84.6%: 15.4%). Median age of patients was 58 (interquartile range [IQR] 50-63) years. Median size of renal tumor (in cms) was 9.5 (IQR 7.5-12), 8 (IQR 7-11.5), 8.5 (IQR 7-11.75), and 11 (IQR 9.5-11) (P = 0.998) in level 1,2,3, and 4 tumors, respectively. Clear cell variant was seen in 32 patients (82%) with R0 resection in 17 patients. Twelve patients (30.7%) had systemic metastasis on presentation. The overall mean survival time was 66.4 months with 95% confidence interval (CI) (52.4-80.5 months). Mean recurrence-free survival is 76 months with (63-90) CI of 95%. Mean survival in patients who presented with metastasis is 47 months with 95% CI (52.4-80.5). Perioperative mortality rate was 5.12% in this study. CONCLUSION The tumor size does not have an influence on the progression of tumor thrombus into IVC. Significant difference in survival was observed between different levels of thrombus with high mortality in level four tumors.
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Affiliation(s)
- Mathisekaran Thangarasu
- Department of Genitourinary Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India,Address for correspondence: Dr. Mathisekaran Thangarasu, Department of Genitourinary Surgery, Apollo Main Hospital, 21, Gream’s Lane, Off Gream’s Road, Chennai - 600 006, Tamil Nadu, India. E-mail:
| | - J. Sanjay Prakash
- Department of Genitourinary Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - Sandeep Bafna
- Department of Genitourinary Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - P. Aarthy
- Department of Genitourinary Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | | | - Balaji Venugopal
- Department of Vascular Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | | | - Nitesh Jain
- Department of Genitourinary Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | | | - Deepak Raghavan
- Department of Genitourinary Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - Murali Venkatraman
- Department of Genitourinary Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - M. Chandranathan
- Department of Biostatistics, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - Rajesh Paul
- Department of Genitourinary Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - Nivash Selvaraj
- Department of Genitourinary Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | | | - Narasimhan Ragavan
- Department of Genitourinary Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
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VIDEOUROLOGY ABSTRACTS. J Endourol 2021. [DOI: 10.1089/end.2021.29117.vid] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Outcomes in Renal Cell Carcinoma with Inferior Vena Cava Thrombus Treated with Surgery. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:96-100. [PMID: 34211754 PMCID: PMC8200613 DOI: 10.12865/chsj.47.01.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/14/2021] [Indexed: 11/28/2022]
Abstract
Introduction. Renal cell carcinoma can invade through the renal vein into the inferior vena cava, and can extend intraluminally, with tumor-thrombus formation. Methods: Retrospective study from January 2003 to August 2016. Surgical outcomes were analyzed. Neves classification was used for patient categorization. Kaplan Meier and Log-Rank test were used for survival analysis. Results: A total of 134 patients were included, 69 males (51.4%) and 65 females (49%), M:F ratio 1.06:1. Tumor size, bleeding and surgical time were higher in level IV thrombi (mean 16.1cm, 3 064ml and 6.5hrs, respectively), compared to level I (8.5cm, 1033ml and 3.1hrs, respectively). A higher frequency of positive lymph nodes was observed in levels III and IV compared with levels I and II (49% vs. 17.7%, p=0.0001). Distant metastases were observed in 36 pts. (27%). Overall surgical mortality was 4.5%. 5-year overall survival was 63%. We observed a 5-year survival in patients with level I-II 82% and level III and IV 46%. Conclusions: Our results suggest the benefit for the patient of an aggressive surgical approach with an acceptable mortality and 5-year survival rate. The results obtained justify an aggressive surgical approach to these tumors.
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Castro-Santa E, Siles-Víquez HD, Castro-Solano K, Brenes-González J, Matamoros MA. First Resection of a Cavoatrial Renal Tumor Thrombus in a Pediatric Patient in Central America Based on a Multistage Surgical Safety Strategy Combining Liver Transplant Techniques and Cardiac Surgery. Case Rep Oncol 2021; 14:47-55. [PMID: 33776681 PMCID: PMC7983646 DOI: 10.1159/000512824] [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: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 11/25/2022] Open
Abstract
We herein report the challenging evaluation and planning process involved in performing the first successful surgical resection of a renal tumor with extensive inferior vena cava tumor thrombosis reaching the right atrium in a pediatric patient within the Central American region. In November 2018, the Oncology Department of the National Children's Hospital in Costa Rica consulted our Center for Liver Transplantation and Hepatobiliary Surgery for the evaluation of a clinical case involving a 6-year-old female patient with progressive Budd-Chiari syndrome caused by a Wilms' tumor of the right kidney with tumor thrombosis of the inferior vena cava reaching the right atrium. A multistage surgical safety strategy combining liver transplant techniques and cardiac surgery was thereafter designed and implemented, achieving complete excision of the tumor thrombus from the inferior vena cava with right nephrectomy. Postoperatively, the patient exhibited complete clinical resolution of Budd-Chiari syndrome and has remained tumor free with excellent quality of life while pursuing her second grade of primary school education 22 months after the successful implementation of this multistage surgical safety strategy. The combination of liver transplantation techniques and cardiac surgery based on a multistage surgical safety strategy minimized the occurrence of unexpected intraoperative events and allowed for complete renal tumor resection and level IV thrombectomy for the first time in a pediatric patient of a public health system in a developing country within the Central American region.
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Affiliation(s)
- Edward Castro-Santa
- Center for Liver Transplantation and Hepatobiliary Surgery, Mexico Hospital, Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica.,Pediatric Liver Transplant Unit, National Children Hospital Costa Rica, Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
| | - Hellen Daniela Siles-Víquez
- Center for Liver Transplantation and Hepatobiliary Surgery, Mexico Hospital, Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica.,Pediatric Liver Transplant Unit, National Children Hospital Costa Rica, Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
| | - Karla Castro-Solano
- Department of Pediatric Cardiac Surgery, National Children Hospital Costa Rica, Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
| | - Javier Brenes-González
- Department of Pediatric Cardiac Surgery, National Children Hospital Costa Rica, Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
| | - María A Matamoros
- Center for Liver Transplantation and Hepatobiliary Surgery, Mexico Hospital, Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica.,Pediatric Liver Transplant Unit, National Children Hospital Costa Rica, Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
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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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Fanelli MCA, Guilhen JCS, Duarte AAB, de Souza FKM, Cypriano MDS, Caran EMM, Lederman HM, de Seixas Alves MT, Abib SDCV. Management of Pediatric Tumors With Vascular Extension. Front Pediatr 2021; 9:753232. [PMID: 35059362 PMCID: PMC8764352 DOI: 10.3389/fped.2021.753232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Pediatric tumors can present with vascular extension to the inferior vena cava and right atrium, which impacts the surgical strategy and can be challenging during surgical treatment. Wilms tumor (WT) is the most common retroperitoneal tumor that can present with vascular extension, but also adrenal tumors, clear cell tumors from the kidney, and hepatoblastomas can present with this situation. Surgical aims include obtaining complete tumor resection without risk for patients, to avoid severe bleeding, cardiac arrest, and embolization, and to avoid cardiac bypass if possible. Objective: To describe and discuss the surgical strategies to deal with pediatric tumors with vascular extension and propose a protocol. Method: Retrospectivly review the experience of treating patients with vascular extension in a single institution, describing different scenarios and a decision making fluxogram based on the preoperative evaluation regarding the surgical techniques and the need for cardiac bypass that are adequate for each situation. Image studies are important to guide the surgical strategy. Depending on the quality of image available, computerized tomography (CT) or magnetic resonance imaging (MRI) can be enough to give the information needed for surgical decisions. Ultrasonography (US) with Doppler is helpful to confirm diagnosis and describes factors to guide the adequate surgical strategy, like the upper level extension and presence or absence of blood flow around the thrombus. Neoadjuvant chemotherapy is indicated in most cases, in order to reduce the upper level of extension (and avoid the need for cardiac bypass) and to lower the risk of embolization. The approach is based on the upper level of the thrombus and can include cavotomy or cavectomy, sometimes with cardiac bypass and cardiac arrest with hypothermia, when the thrombus reaches the diaphragmatic level or above. Pathology analysis of the thrombus can guide staging and the need for radiotherapy postoperatively. Results: A decision making fluxogram protocol is presented focusing on the surgical treatment of such condition. Conclusion: Surgery strategy is highly impacted by the presence of vascular extension in pediatric tumors. Surgeons should be aware of potential complications and how to prevent them. Such cases should be treated in reference centers.
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Affiliation(s)
- Mayara Caroline Amorim Fanelli
- Department of Pediatric Surgery, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil
| | | | - Alexandre Alberto Barros Duarte
- Department of Pediatric Surgery, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil
| | | | - Monica Dos Santos Cypriano
- Department of Pediatric Oncology, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil
| | - Eliana Maria Monteiro Caran
- Department of Pediatric Oncology, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil
| | - Henrique Manoel Lederman
- Department of Pediatric Radiology, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil
| | - Maria Teresa de Seixas Alves
- Department of Pediatric Surgery, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil.,Department of Pediatric Pathology, Federal University of São Paulo, São Paulo, Brazil
| | - Simone de Campos Vieira Abib
- Department of Pediatric Surgery, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil.,Department of Pediatric Surgery, Federal University of São Paulo, São Paulo, Brazil
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24
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Ghoreifi A, Djaladat H. Surgical Tips for Inferior Vena Cava Thrombectomy. Curr Urol Rep 2020; 21:51. [PMID: 33090290 DOI: 10.1007/s11934-020-01007-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to describe the preoperative evaluation, surgical techniques, and postoperative management of patients with renal cell carcinoma (RCC) undergoing radical nephrectomy (RN) and inferior vena cava (IVC) thrombectomy. RECENT FINDINGS RN and IVC thrombectomy remains the standard management option in non-metastatic RCC patients with IVC thrombus. A comprehensive preoperative workup, including high-quality imaging, blood works, and appropriate consultations are required for all patients. The aim of the surgery is complete resection of all tumor burden, which requires a skillful surgical team for such a challenging procedure and is inherently associated with a high rate of perioperative morbidity and mortality. Preoperative CT or MRI is essential for surgical planning. The surgical approach is mainly determined by the level of the tumor thrombus. The open approach has been the standard, though minimally invasive and robotic techniques are emerging in selected cases by experienced surgeons.
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Affiliation(s)
- Alireza Ghoreifi
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave. Suite 7416, Los Angeles, CA, 90089, USA
| | - Hooman Djaladat
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave. Suite 7416, Los Angeles, CA, 90089, USA.
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A Predictive Model for Tumor Invasion of the Inferior Vena Cava Wall Using Multimodal Imaging in Patients with Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9530618. [PMID: 33083491 PMCID: PMC7563051 DOI: 10.1155/2020/9530618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/14/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022]
Abstract
Purpose Developed a preoperative prediction model based on multimodality imaging to evaluate the probability of inferior vena cava (IVC) vascular wall invasion due to tumor infiltration. Materials and Methods We retrospectively analyzed the clinical data of 110 patients with renal cell carcinoma (RCC) with level I-IV tumor thrombus who underwent radical nephrectomy and IVC thrombectomy between January 2014 and April 2019. The patients were categorized into two groups: 86 patients were used to establish the imaging model, and the data validation was conducted in 24 patients. We measured the imaging parameters and used logistic regression to evaluate the uni- and multivariable associations of the clinical and radiographic features of IVC resection and established an image prediction model to assess the probability of IVC vascular wall invasion. Results In all of the patients, 46.5% (40/86) had IVC vascular wall invasion. The residual IVC blood flow (OR 0.170 [0.047-0.611]; P = 0.007), maximum coronal IVC diameter in mm (OR 1.203 [1.065-1.360]; P = 0.003), and presence of bland thrombus (OR 3.216 [0.870-11.887]; P = 0.080) were independent risk factors of IVC vascular wall invasion. We predicted vascular wall invasion if the probability was >42% as calculated by: {Ln [Pre/(1 - pre)] = 0.185 × maximum cornal IVC diameter + 1.168 × bland thrombus-1.770 × residual IVC blood flow-5.857}. To predict IVC vascular wall invasion, a rate of 76/86 (88.4%) was consistent with the actual treatment, and in the validation patients, 21/26 (80.8%) was consistent with the actual treatment. Conclusions Our model of multimodal imaging associated with IVC vascular wall invasion may be used for preoperative evaluation and prediction of the probability of partial or segmental IVC resection.
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Shen D, Du S, Huang Q, Gao Y, Fan Y, Gu L, Liu K, Peng C, Xuan Y, Li P, Li H, Ma X, Zhang X, Wang B. A modified sequential vascular control strategy in robot-assisted level III-IV inferior vena cava thrombectomy: initial series mimicking the open 'milking' technique principle. BJU Int 2020; 126:447-456. [PMID: 32330369 DOI: 10.1111/bju.15094] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To introduce a modified sequential vascular control strategy, mimicking the open 'milking' technique principle, for the early release of the first porta hepatis (FPH) and to stop cardiopulmonary bypass (CPB) in level III-IV robot-assisted inferior vena cava (IVC) thrombectomy (RA-IVCTE). PATIENTS AND METHODS From November 2014 to June 2019, 27 patients with a level III-IV IVC tumour thrombus (IVCTT) underwent RA-IVCTE in our department. The modified sequential control strategy was used in 12 cases. Previously, we released the FPH after the thrombus was resected and the IVC was closed completely, and CPB was stopped at the end of surgery (15 patients). Presently, using our modified strategy, we place another tourniquet inferior to the second porta hepatis (SPH) once the proximal thrombus is removed from the IVC below the SPH. Then, we suture the right atrium and perform early release of the FPH, and stop CPB. Finally, tumour thrombectomy, vascular reconstruction, and radical nephrectomy are performed. RESULTS Compared with the previous strategy, the modified steps resulted in a shorter median FPH clamping (19 vs 47 min, P < 0.001) and CPB times (60 vs 87 min, P < 0.05); a lower rate of Grade II-IV perioperative complications (25% vs 60%, P < 0.05); and better postoperative hepatorenal and coagulation function, including better median serum alanine aminotransferase (172.7 vs 465.4 U/L, P < 0.001), aspartate aminotransferase (282.4 vs 759.8 U/L, P < 0.001), creatinine (113.4 vs 295 μmol/L, P < 0.01), blood urea nitrogen (7.3 vs 16.7 mmol/L, P < 0.01), and D-dimer (5.9 vs 20 mg/L, P < 0.001) levels. CONCLUSION With the early release of the FPH and stopping CPB, the modified sequential vascular control strategy in level III-IV RA-IVCTE reduced the perioperative risk for selected patients and improved the feasibility and safety of the surgery. We would recommend this approach to other centres that plan to develop robotic surgery for renal cell carcinoma with level III-IV IVCTT in the future.
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Affiliation(s)
- Donglai Shen
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Songliang Du
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Qingbo Huang
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Yu Gao
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Yang Fan
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Liangyou Gu
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Kan Liu
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Cheng Peng
- Department of Urology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yundong Xuan
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Pin Li
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hongzhao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Xin Ma
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Xu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Baojun Wang
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
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Wang Y, Wang X, Chang Y. Radical nephrectomy combined with removal of tumor thrombus from inferior vena cava under real-time monitoring with transesophageal echocardiography: A case report. Medicine (Baltimore) 2020; 99:e19392. [PMID: 32176064 PMCID: PMC7220393 DOI: 10.1097/md.0000000000019392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Renal carcinoma is a common malignant tumor of the urinary system, 4%-10% of which are complicated with tumor thrombi in the renal vein and the inferior vena cava; in about 1% of patients, the inferior vena cava tumor thrombus invades the right atrium. Surgery is the treatment of choice. Real-time monitoring with transesophageal echocardiography (TEE) has been widely used in various operations, including cardiac and non-cardiac operations for congenital heart diseases, coronary diseases, vascular heart diseases, and aorta diseases, etc. In this article, a case of a patient with right renal carcinoma complicated with an inferior vena cava tumor thrombus is reported. PATIENT CONCERNS A 52-year-old man who was admitted to our hospital for lumbar pain lasting for one month. DIAGNOSIS Right renal carcinoma complicated with an inferior vena cava tumor thrombus. INTERVENTIONS Radical nephrectomy of the renal carcinoma and removal of an inferior vena cava tumor thrombus under real-time monitoring with TEE were performed. OUTCOMES Radical nephrectomy was successfully performed within 5 minutes after the inferior vena cava was clamped, and then the inferior vena cava tumor thrombus was removed. On the second day after the operation, the patient's conditions improved; his consciousness was clear; he was transferred to a general ward. On the third day after the operation, the patient was able to get out of bed and was discharged on the sixth day after the operation. LESSONS Real-time monitoring with TEE played an important role in many aspects in the radical nephrectomy of the renal carcinoma and removal of the inferior vena cava tumor thrombus.
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Affiliation(s)
- Yaozhu Wang
- Department of Anesthesiology, Shandong Provincial ENT Hospital, Shandong Provincial ENT Hospital affiliated to Shandong University
| | - Xu Wang
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong University. Jinan 250021, Shandong Province, China
| | - Yuan Chang
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong University. Jinan 250021, Shandong Province, China
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Lin W, Watts KL, Davuluri M, Aboumohamed A. Non-Familial Synchronous Bilateral Renal Cell Carcinoma with Bilateral Synchronous Renal Vein Extension and Inferior Vena Cava Thrombus. Curr Urol 2019; 13:51-53. [PMID: 31579217 DOI: 10.1159/000499294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/14/2018] [Indexed: 11/19/2022] Open
Abstract
Bilateral renal cell carcinoma with tumor thrombus extension into the renal vein and/or inferior vena cava - clinical stage T3a+ - is rare. The majority of these cases arise due to a genetic predisposition. We present a case report of a 47-year-old male with bilateral, synchronous renal cell carcinoma with bilateral renal vein and inferior vena cava tumor thrombi with no identifiable familial predisposition.
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Affiliation(s)
| | - Kara L Watts
- Albert Einstein College of Medicine.,Montefiore Medical Center, Department of Urology, Bronx, NY, USA
| | | | - Ahmed Aboumohamed
- Albert Einstein College of Medicine.,Montefiore Medical Center, Department of Urology, Bronx, NY, USA
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Calderone CE, Tuck BC, Gray SH, Porter KK, Rais-Bahrami S. The role of transesophageal echocardiography in the management of renal cell carcinoma with venous tumor thrombus. Echocardiography 2018; 35:2047-2055. [DOI: 10.1111/echo.14187] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- Carli E. Calderone
- Department of Urology; University of Alabama at Birmingham; Birmingham Alabama
| | - Benjamin C. Tuck
- Department of Anesthesiology; University of Alabama at Birmingham; Birmingham Alabama
| | - Stephen H. Gray
- Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama
| | - Kristin K. Porter
- Department of Radiology; University of Alabama at Birmingham; Birmingham Alabama
| | - Soroush Rais-Bahrami
- Department of Urology; University of Alabama at Birmingham; Birmingham Alabama
- Department of Radiology; University of Alabama at Birmingham; Birmingham Alabama
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Abstract
Robot assistance has been rapidly adopted by urological surgeons and has become particularly popular for oncological procedures involving the retroperitoneal space. The wide dissemination of robot assistance probably reflects the limited amount of operating space available within the retroperitoneum and the advantages provided by robot-assisted approaches, including 3D imaging, wristed instrumentation and the shorter learning curve compared with that associated with the equivalent laparoscopic techniques. Surgical procedures that have traditionally been performed using an open or laparoscopic approach, such as partial nephrectomy, radical nephrectomy, retroperitoneal lymph node dissection, nephroureterectomy and adrenalectomy, are now often being performed using robot assistance. The frontiers of robot-assisted retroperitoneal oncological surgery are constantly expanding, with an emphasis on maintaining oncological and functional outcomes, while minimizing the level of surgical invasiveness.
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Palacios-Zertuche J, Rodríguez-Briseño J, Martínez-Zarazúa R, Reyna-Sepúlveda F, Muñoz-Maldonado G. Resección de vena cava y colocación de injerto de dacrón con reimplante de vena renal izquierda debido a trombosis tumoral de vena cava por carcinoma de células renales. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2016.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fukushima S, Uemura M, Gotoh K, Ujike T, Wada H, Miyagawa S, Toda K, Sawa Y. Xeno-pericardial patch repair of the inferior vena cava for radical resection of renal cell carcinoma with tumor thrombus. J Surg Oncol 2017; 116:775-782. [PMID: 28608432 PMCID: PMC5724493 DOI: 10.1002/jso.24709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/13/2017] [Indexed: 01/24/2023]
Abstract
Background and Objectives For tumor thrombus in the inferior vena cava (IVC) complicated with kidney cancer, we built a surgical team to achieve (1) en bloc tumor resection; (2) xeno‐pericardial patch IVC repair; and (3) minimum organ damages. We reviewed outcome of the case series to verify rationale of this approach. Methods A consecutive series of 12 patients having the IVC tumor thrombus by renal cell carcinoma in the last 3 years was enrolled. Minimum kidney ischemia was induced in five cases (Procedure I), whereas liver and kidney ischemia was induced in five cases (Procedure II). Mild hypothermic extracorporeal circulation was used in two cases (Procedure III). Results There was no mortality or severe morbidities related to the surgery. Postoperative recovery was most prompt by the Procedure I. Liver and kidney ischemic time was longer in the Procedure III than the Procedure II, whereas organ function was not substantially impaired in either series. The resected IVC margin was free from the cancer in all cases, while local recurrence was not seen in any cases. Conclusions En bloc resection with xeno‐pericardial patch repair of the IVC was successfully performed in the tumor thrombus complicated with kidney cancer with minimum organ damage.
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Affiliation(s)
- Satsuki Fukushima
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kunihito Gotoh
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takeshi Ujike
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Hofer L, Gasch C, Hatiboglu G, Motsch J, Grüllich C, Duensing S, Hohenfellner M. [Level IV inferior vena cava tumor thrombus : A rare diagnosis in patients with renal cell carcinoma]. Urologe A 2017; 56:868-875. [PMID: 28349189 DOI: 10.1007/s00120-017-0369-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Renal cell carcinoma in combination with a supradiaphragmatic tumor thrombus is a rare tumor entity. Radical surgery including nephrectomy and thrombectomy is still considered standard treatment. The extent of the tumor thrombus should be preoperatively evaluated by MRI and TEE. An interdisciplinary team is important for surgery planning and realization. Despite the known risks of an operation, a longer overall survival is achieved.
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Affiliation(s)
- L Hofer
- Urologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - C Gasch
- Urologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - G Hatiboglu
- Urologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - J Motsch
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C Grüllich
- Klinik für Medizinische Onkologie, Nationales Zentrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - S Duensing
- Urologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - M Hohenfellner
- Urologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
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Spelde A, Steinberg T, Patel PA, Garcia H, Kukafka JD, MacKay E, Gutsche JT, Frogel J, Fabbro M, Raiten JM, Augoustides JGT. Successful Team-Based Management of Renal Cell Carcinoma With Caval Extension of Tumor Thrombus Above the Diaphragm. J Cardiothorac Vasc Anesth 2017; 31:1883-1893. [PMID: 28502456 DOI: 10.1053/j.jvca.2017.02.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Audrey Spelde
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Toby Steinberg
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Harry Garcia
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jeremy D Kukafka
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emily MacKay
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jonathan Frogel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael Fabbro
- Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - Jessie M Raiten
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Gerstein NS, Zhang R, Davis MS, Ram H. Lessons Still Being Learned: Acute Pulmonary Tumor Embolus During Renal Cell Carcinoma Resection. ACTA ACUST UNITED AC 2017; 7:172-176. [PMID: 27552241 DOI: 10.1213/xaa.0000000000000378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Renal cell carcinoma (RCC) is the most common primary renal neoplasm and is associated with the intraluminal growth into the venous system with possible extension into the inferior vena cava or even right heart. Intraoperative pulmonary embolism is a complication of resection of RCC, which may be mitigated by the use of the cardiopulmonary bypass with or without deep hypothermic circulatory arrest. We present a case of unexpected pulmonary embolism diagnosed during RCC surgery. The case highlights the central importance of intraoperative transesophageal echocardiography use and the need for proper preoperative planning for the use of cardiopulmonary bypass.
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Affiliation(s)
- Neal S Gerstein
- From the *Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico; and †Division of Urology, Department of Surgery, University of New Mexico, Albuquerque, New Mexico
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