Laparoscopic vena cava thrombectomy for a right kidney tumor with level II thrombus

Abstract Background It has been suggested that IVC reconstruction of retroperitoneal tumors is not required when adequate collateral circulation is present, though transient rise in creatinine may occur post-operatively. There are no reports evaluating mid- and long-term effect on renal function in these patients. The purpose of this study is to assess whether resection of a right renal cell carcinoma and inferior vena cava with obstructing tumor thrombus is safe to perform without reconstructing the inferior vena cava with regard to long-term renal function. Materials and Methods A bi-institutional retrospective review was performed over an 18 year period, assessing patients with right renal cell carcinoma and obstructing level II-IV tumor thrombus. Results Twenty-two patients were included in the study. Median age was 62.5 (range 45-79) years old and 19 (86%) of the patients were male. One patient (5%) had a level II thrombus, 14 patients (64%) had a level III thrombus (IIIa n=3, IIIb n=6, IIIc n= 3, IIId n=2), and seven patients (32%) had a level IV thrombus. Intra-operatively, median estimated blood loss was 1.35 (range 0.2 – 25) L. The median length of hospital stay was 11 (range 5 – 50) days. Median preoperative creatinine was 1.20 (range 0.40 – 2.70) mg/dL and postoperatively, median creatinine was 1.3 (range 0.86 – 2.20) mg/dL. Median creatinine at 6 month and 12 months follow-up was 1.10 (range 0.5 – 1.6) and mg/dL 1.34 (range 0.6 – 2.0), respectively. Eight patients were lost to follow-up, and two died (one in the hospital, and the other three months post-operatively). Conclusions Resection of right renal cell carcinoma with inferior vena cava in the presence of an obstructing level II- IV tumor thrombus without reconstruction of the inferior vena cava appears not to have a significant adverse effect on long-term renal function.

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MP66-04 COMPARISON OF ROBOTIC AND OPEN TECHNIQUES IN PATIENTS UNDERGOING RADICAL NEPHRECTOMY AND LEVEL II/III INFERIOR VENA CAVA THROMBECTOMY

The Journal of Urology ◽

10.1016/j.juro.2018.02.1876 ◽

2018 ◽

Vol 199 (4S) ◽

Author(s):

Alp Tuna Beksac ◽

David Paulucci ◽

John P. Sfakianos ◽

Reza Mehrazin ◽

Ronney Abaza ◽

...

Keyword(s):

Inferior Vena Cava ◽

Radical Nephrectomy ◽

Inferior Vena ◽

Vena Cava ◽

Level Ii

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Renal Cell Carcinoma with Level II Inferior Vena Cava Thrombi: Operative Steps

Surgical Case Reports ◽

10.31487/j.scr.2021.03.12 ◽

2021 ◽

pp. 1-3

Author(s):

R. B. Nerli ◽

Priyeshkumar Patel ◽

Shridhar C. Ghagane ◽

Shashank Patil ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Inferior Vena Cava ◽

Cell Carcinoma ◽

Renal Cell ◽

Inferior Vena ◽

Prognostic Significance ◽

Vena Cava ◽

Term Survival ◽

Level Ii ◽

Diagnostic Modalities

The incidence of venous tumor thrombi extension to the inferior vena cava (IVC) in renal cell carcinoma (RCC) has markedly increased recently due to the advances in diagnostic modalities. Such vascular invasion implies a heightened biologic behaviour and a surgical challenge during the course of treatment. Several studies have examined the prognostic significance of the level of venous extension. It has been suggested recently that long-term survival may be significantly better in patients with renal vein involvement than IVC involvement. We describe the operative steps in the treatment of level II IVC thrombus in this report.

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V01-11 ROBOT-ASSISTED LEVEL II AND III INFERIOR VENA CAVA THROMBECTOMY

The Journal of Urology ◽

10.1097/ju.0000000000000826.011 ◽

2020 ◽

Vol 203 ◽

pp. e93

Author(s):

Gilberto Rodrigues* ◽

Arnaldo Fazoli ◽

Luís Tanure ◽

Giuliano Guglielmetti ◽

Maurício Cordeiro ◽

...

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Robot Assisted ◽

Level Ii

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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.v7i2.149 ◽

2020 ◽

Vol 7 (2) ◽

pp. 11-17

Author(s):

Abdul 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 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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Anesthetic management of radical nephrectomy in patients with renal cell carcinoma involving renal vein or inferior vena cava

Tumori Journal ◽

10.1177/0300891619839295 ◽

2019 ◽

Vol 105 (5) ◽

pp. 411-416

Author(s):

Kun Chen ◽

Juan Wang ◽

Jinzhen Dai ◽

Ailin Luo ◽

Yuke Tian ◽

...

Keyword(s):

Blood Loss ◽

Renal Vein ◽

Radical Nephrectomy ◽

Inferior Vena ◽

Anesthetic Management ◽

Vena Cava ◽

Operation Time ◽

Level Ii ◽

Estimated Blood Loss ◽

The Mean

Objective: To investigate the perioperative anesthetic management of patients diagnosed with renal cell carcinoma (RCC) metastasized into the renal vein or inferior vena cava (IVC) after undergoing radical nephrectomy to provide clinical evidence for rational anesthetic interventions. Methods: A total of 81 patients with RCC extending into the renal vein or IVC, aged 17–73 years, undergoing radical nephrectomy were recruited. Preoperative status, intraoperative management, average operation time, average estimated blood loss, postanesthesia outcomes, and postoperative complications were retrospectively analyzed. Results: The mean operation time was 288 minutes (range 146–825 minutes). The mean estimated blood loss was recorded as 1905 mL (range 200–7000 mL). Among 81 cases, 9 patients (11.1%, 1 level II, 3 level III, and 5 level IV) were switched to undergo cardiopulmonary bypass. Significant hemodynamic fluctuations were observed in 39 patients who presented with level II–IV of tumor thrombus. One patient had pulmonary embolism and died of active cardiopulmonary resuscitation. The mean postoperative hospital stay was 12.8 days. Twenty-five cases with level III–IV tumor thrombus were transferred to the intensive care unit with endotracheal intubation due to massive intraoperative blood loss. The remaining 55 cases were transferred to the postanesthesia care unit 2 hours before being transferred to the ward. One patient had postoperative acute coronary syndrome and was discharged after effective interventions. Conclusion: Anesthetic management and intensive postoperative care play a pivotal role in the success of complete resection of RCC that metastasize into the IVC.

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Leiomyosarcoma of the inferior vena cava level II involvement: curative resection and reconstruction of renal veins

World Journal of Surgical Oncology ◽

10.1186/1477-7819-10-120 ◽

2012 ◽

Vol 10 (1) ◽

pp. 120 ◽

Cited By ~ 9

Author(s):

Quan Wang ◽

Jing Jiang ◽

Chao Wang ◽

Guodong Lian ◽

Mei-Shan Jin ◽

...

Keyword(s):

Inferior Vena Cava ◽

Curative Resection ◽

Inferior Vena ◽

Vena Cava ◽

Renal Veins ◽

Level Ii

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A case report of simultaneous mini-invasive treatment of a patient with kidney tumor and tumor thrombus in inferior vena cava

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2018-3-81-85 ◽

2018 ◽

Vol 22 (3) ◽

pp. 69

Author(s):

M. S. Mosoyan ◽

M. A. Chernyavskiy ◽

A. V. Chernov ◽

M. E. Mamsurov ◽

I. O. Chuykova

Keyword(s):

Informed Consent ◽

Inferior Vena Cava ◽

Minimally Invasive ◽

Conflict Of Interest ◽

Inferior Vena ◽

Vena Cava ◽

Kidney Tumor ◽

Invasive Treatment ◽

Rehabilitation Period ◽

The Right

Nowadays, there is a tendency in surgery to use more minimally invasive surgical procedures to decrease the risk of intra- and postoperative complications and to reach a faster rehabilitation period. We report a case of successful simultaneous minimally invasive treatment of a patient with kidney tumor. According to ultrasound examination data, the patient had a tumor in the right kidney. A computed tomography scan of the abdomen verified the tumor and detected a thrombus in the inferior vena cava lumen. Embolization of the right renal artery was performed as the first stage in the hybrid operating room. Right-side nephrectomy and thrombectomy from inferior vena cava, as the second stage, were done by using a robotic surgical system. The feature of this case is that embolization and nephrectomy were simultaneously performed during one surgical procedure. On the 10th day, the patient was discharged from the hospital without any signs of deterioration and complications. Thus, the unique work of two surgical teams proficient in mini-invasive technologies allowed to eliminate tumors and tumor thrombi in a single procedure and to reduce the bleeding, in-hospital stay, and rehabilitation period. This method will help more patients with kidney tumors in the future.Received 28 June 2018. Revised 3 August 2018. Accepted 6 August 2018. Informed consent: The patient’s informed consent to use his records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest.

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