911Renal cell carcinoma with neoplastic thrombosis of the intrahepatic, suprahepatic inferior vena cava and/or right atrium: Patient selection, surgical technique and oncological radicality

Aim: “To evaluate oncological and surgical outcomes of different levels of tumor thrombus and tumor characteristics secondary to renal cell carcinoma (RCC)”.Materials and Methods: Retrospective review from 2013 to 2020 of 34 patients who underwent radical nephrectomy with thrombectomy for RCC with tumor thrombus extending into the inferior vena cava (IVC) and right atrium (RA) at our center. Level I and most level II tumors were removed using straight forward occluding maneuvers with control of the contralateral renal vein. None of the patients had level III tumor extensions in our study group. For level IV thrombus, a beating heart surgery using a simplified cardiopulmonary bypass (CPB) technique was used for retrieval of thrombus from the right atrium. Results: “Of the 34 patients with thrombus”, 19 patients had level I, 12 patients had level II, none had level III, and three patients had level IV thrombus. Two patients required simplified CPB. Another patient with level IV thrombus CPB, was not attempted in view of refractory hypoten-sion intraoperatively. Pathological evaluation showed clear-cell carcinoma in 67.64%, papillary carcinoma in 17.64%, chromophobe in 5.8%, and squamous cell carcinoma in 8.8% of cases. Left side thrombectomy was difficult surgically, whereas right side thrombectomy did not have any sur-vival advantage. Mean blood loss during the procedure was 325 mL, ranging from 200 to 1000 mL, and mean operative time was 185 min, ranging from 215 to 345 min. The immediate postoperative mortality was 2.9%. Level I thrombus had better survival compared to level II thrombus. Conclusion: Radical nephrectomy with tumor thrombectomy remains the mainstay of treatment in RCC with inferior venacaval extension. The surgical approach and outcome depends on primary tumor size, location, level of thrombus, local invasion of IVC, any hepato-renal dysfunction or any associated comorbidities. The higher the level of thrombus, the greater is the need for prior optimization and the adoption of a multidis-ciplinary approach for a successful surgical outcome.

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Selective Upper-Body Perfusion Technique for Removal of Renal Cell Carcinoma Extending into the Inferior Vena Cava and Right Atrium

Texas Heart Institute Journal ◽

10.14503/thij-16-6011 ◽

2017 ◽

Vol 44 (4) ◽

pp. 283-286

Author(s):

Selim Aydin ◽

Bora Cengiz ◽

Banu Vural Gokay ◽

Anar Mammadov ◽

Remzi Emiroglu ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Inferior Vena Cava ◽

Cell Carcinoma ◽

Right Atrium ◽

Renal Cell ◽

Inferior Vena ◽

Vena Cava ◽

Upper Body ◽

Surgical Field ◽

The Right

Invasion of a renal cell carcinoma thrombus into the inferior vena cava and right atrium is infrequent. Reaching and completely excising a tumor from the inferior vena cava is particularly challenging because the liver covers the surgical field. We report the case of a 61-year-old man who underwent surgery for a renal cell carcinoma of the right kidney that extended into the inferior vena cava and right atrium. During dissection of the liver to expose the inferior vena cava, transesophageal echocardiograms revealed right atrial mass migration into the tricuspid valve. On emergency sternotomy, the tumor embolized into the main pulmonary artery. We used a selective upper-body perfusion technique involving moderately hypothermic cardiopulmonary bypass, cardioplegic arrest, and clamping of the descending aorta, which provided a bloodless surgical field for precise removal of the mass and resulted in minimal blood loss. Our technique might be useful in other patients with tumor thrombus extending into the right atrium because it reduces the need for transfusion and avoids the deleterious effects of deep hypothermic circulatory arrest. Our case also illustrates the importance of continuous transesophageal echocardiographic monitoring to detect thrombus embolization.

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Tumor thrombosis of the inferior vena cava and right atrium in patients with renal cell carcinoma: 25-year experience of surgical treatment

Acta Medica Leopoliensia ◽

10.25040/aml2019.01.031 ◽

2019 ◽

Vol 25 (1) ◽

pp. 31-38

Author(s):

I.I. Kobza ◽

◽

Yu.S. Mota ◽

S.A. Lebedeva ◽

R.A. Zhuk ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Surgical Treatment ◽

Inferior Vena Cava ◽

Cell Carcinoma ◽

Right Atrium ◽

Renal Cell ◽

Inferior Vena ◽

Vena Cava ◽

Tumor Thrombosis

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Renal Cell Carcinoma With Extensive Tumor Thrombus Into the Inferior Vena Cava and Right Atrium in a 70-Year-Old Man

American Journal of Men s Health ◽

10.1177/1557988319846404 ◽

2019 ◽

Vol 13 (3) ◽

pp. 155798831984640 ◽

Cited By ~ 3

Author(s):

Monica-Alexandra Oltean ◽

Roxana Matuz ◽

Adela Sitar-Taut ◽

Anca Mihailov ◽

Nicolae Rednic ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Inferior Vena Cava ◽

Cell Carcinoma ◽

Right Atrium ◽

Renal Cell ◽

Tumor Thrombus ◽

Inferior Vena ◽

Vena Cava

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Renal Cell Carcinoma with Thrombus Extension into the Inferior Vena Cava and the Right Atrium: A Case Report

CASE ◽

10.1016/j.case.2020.05.004 ◽

2020 ◽

Vol 4 (4) ◽

pp. 274-277

Author(s):

Ahmed Abdelfattah ◽

Mohamed El Wazir ◽

Yehia Z. Ali ◽

Jwan Naser ◽

Brandon M. Wiley

Keyword(s):

Renal Cell Carcinoma ◽

Case Report ◽

Inferior Vena Cava ◽

Cell Carcinoma ◽

Right Atrium ◽

Renal Cell ◽

Inferior Vena ◽

Vena Cava ◽

The Right

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Surgical Outcome of Renal Cell Carcinoma with Tumor Thrombus Extension into Inferior Vena Cava and Right Atrium (Beating Heart Removal of Level 4 Thrombus): A Challenging Scenario

Journal of Kidney Cancer and VHL ◽

10.15586/jkcvhl.2020.149 ◽

2020 ◽

Vol 7 (2) ◽

pp. 11-17

Author(s):

Abdul Rouf Khawaja ◽

Khalid Sofi ◽

Yasir Dar ◽

Muzaain Khateeb ◽

Javeed Magray ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Inferior Vena Cava ◽

Cell Carcinoma ◽

Right Atrium ◽

Tumor Thrombus ◽

Inferior Vena ◽

Vena Cava ◽

Beating Heart ◽

Level Ii ◽

Level I

Aim: “To evaluate oncological and surgical outcomes of different levels of tumor thrombus and tumor characteristics secondary to renal cell carcinoma (RCC)”. Materials and Methods: Retrospective review from 2013 to 2020 of 34 patients who underwent radical nephrectomy with thrombectomy for RCC with tumor thrombus extending into the inferior vena cava (IVC) and right atrium (RA) at our center. Level I and most level II tumors were removed using straight forward occluding maneuvers with control of the contralateral renal vein. None of the patients had level III tumor extensions in our study group. For level IV thrombus, a beating heart surgery using a simplified cardiopulmonary bypass (CPB) technique was used for retrieval of thrombus from the right atrium. Results: “Of the 34 patients with thrombus”, 19 patients had level I, 12 patients had level II, none had level III, and three patients had level IV thrombus. Two patients required simplified CPB. Another patient with level IV thrombus CPB, was not attempted in view of refractory hypotension intraoperatively. Pathological evaluation showed clear-cell carcinoma in 67.64%, papillary carcinoma in 17.64%, chromophobe in 5.8%, and squamous cell carcinoma in 8.8% of cases. Left side thrombectomy was difficult surgically, whereas right side thrombectomy did not have any survival advantage. Mean blood loss during the procedure was 325 mL, ranging from 200 to 1000 mL, and mean operative time was 185 min, ranging from 215 to 345 min. The immediate postoperative mortality was 2.9%. Level I thrombus had better survival compared to level II thrombus. Conclusion: Radical nephrectomy with tumor thrombectomy remains the mainstay of treatment in RCC with inferior venacaval extension. The surgical approach and outcome depends on primary tumor size, location, level of thrombus, local invasion of IVC, any hepato-renal dysfunction or any associated comorbidities. The higher the level of thrombus, the greater is the need for prior optimization and the adoption of a multidisciplinary approach for a successful surgical outcome.

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