Una Soluzione Economica per il Trattamento Della Trombosi Cavale Intraepatica Nell'anziano: Intrahepatic Tumour Trombectomy: An Economic Therapeutic Option in Elderly Patients

Radical excision of renal cancer with propagation into the intrahepatic and intrapericardial inferior vena cava (IVC) has become an accepted surgical approach. We present a case of left radical nephrectomy for renal cancer with IVC sovrahepatic involvement, in which we verified the possibility of approaching the intrapericardial IVC through a limited diaphragmatic incision, thereby avoiding the more invasive sternotomy. The advantages of this approach are: lesser invasiveness, simpler control of the upper extension of the thrombus and decreased blood loss.

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Radical nephrectomy and intracaval thrombectomy for advanced renal cancer with extensive inferior vena cava involvement utilising cardiopulmonary bypass and hypothermic circulatory arrest: Is it worthwhile?

Arab Journal of Urology ◽

10.1016/j.aju.2018.06.005 ◽

2018 ◽

Vol 16 (4) ◽

pp. 378-385

Author(s):

Hosam Serag ◽

Jonathan M. Featherstone ◽

David F. Griffiths ◽

Dheeraj Mehta ◽

John Dunne ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Inferior Vena Cava ◽

Renal Cancer ◽

Radical Nephrectomy ◽

Inferior Vena ◽

Circulatory Arrest ◽

Vena Cava ◽

Hypothermic Circulatory Arrest ◽

Advanced Renal Cancer

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Resection of Large Urological Tumors With or Without Inferior Vena Cava Extension in Jehova's Witnesses

Frontiers in Surgery ◽

10.3389/fsurg.2020.622110 ◽

2020 ◽

Vol 7 ◽

Author(s):

Gaetano Ciancio ◽

Javier Gonzalez

Keyword(s):

Blood Loss ◽

Inferior Vena Cava ◽

Surgical Approach ◽

Tumor Thrombus ◽

Inferior Vena ◽

Perioperative Complications ◽

Vena Cava ◽

Renal Tumors ◽

Adrenal Tumors ◽

Estimated Blood Loss

Background: Renal and adrenal tumors with/without tumor thrombus in the inferior vena cava (IVC) pose a challenge to the surgeon due to the potential for massive hemorrhage and tumor thromboemboli. The situation would be more critical for Jehovah's Witness (JW) patients which refuse blood transfusion. A transplant-based (TB) approach to these tumors in JWs would result a safe surgical method, providing limited blood loss and perioperative complications. We report our experience using a TB surgical approach in JW harboring large adrenal/renal tumors with/without tumor thrombus trying to determine its usefulness in this setting.Patients and Methods: From 2003 to 2011, 7 patients underwent resection of renal/adrenal tumors with/without tumor thrombus in the IVC by means of a TB approach. Thrombus level was renal (n = 2), retrohepatic (n = 1), and suprahepatic (n = 1). The remaining 3 patients did not present thrombus. No pre-operative optimization or cell-saver were used. Estimated blood loss, perioperative complications (Clavien-Dindo and cause), hemoglobin/hematocrit loss, and length of stay were considered main outcomes.Results: The intervention was successfully completed without transfusion in all cases. Operative time and blood loss were 2.5 h (range: 1.83–5.75) and 150 cc (range: 100–750), respectively. No major post-operative complications were registered. However, minor complications were detected in 57% of the patients included. Median hemoglobin loss was 1.13 mg/dL, which translated a median hematocrit loss of 2.3%. Patients were discharged in a median of 7 days (range 5–20).Conclusions: A TB-surgical approach provides enhanced retroperitoneal exposure and optimal vascular control, thus limiting operative blood loss or major complication development, thus resulting useful in JWs.

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Multidisciplinary surgical approach to renal cancer with vena cava invasion and pulmonary embolism

10.33699/pis.2021.100.2.88-93 ◽

2021 ◽

Vol 100 (2) ◽

Keyword(s):

Pulmonary Artery ◽

Inferior Vena Cava ◽

Ct Scan ◽

Renal Cancer ◽

Radical Nephrectomy ◽

Tumor Thrombus ◽

Inferior Vena ◽

Good Condition ◽

Vena Cava ◽

Surgical Removal

Introduction: Renal cancer is unique for many reasons. One reason is that renal cell carcinoma can grow directly into the drainage veins of the kidney, which enter the inferior vena cava leading to the heart. This growth of tumor cells into the veins is called a tumor thrombus and is a locally aggressive renal cancer. The present article informs about the experience of our cardiac surgery department together with the transplant surgery department in successful surgical removal of a kidney with tumor, with invasion into the inferior vena cava, right atrium of the heart and pulmonary artery in two case reports. Case Reports: A 32 years old female without significant history, with suddenly evolving dyspnea was urgently admitted to hospital. Her condition was suspected to be caused by pulmonary artery embolisation. The diagnosis was confirmed by CT scan which revealed unknown tumor mass of the right kidney and tumor embolisation in inferior vena cava and pulmonary artery. The patient was urgently operated by a vascular surgeon and cardiothoracic surgeon. They successfully performed left radical nephrectomy and total thromboembolectomy of the tumorous masses from vena cava inferior and pulmonary artery. The postoperative course was without complications, postoperative CT revealed no residual masses, and the patient was discharged in a good condition from the hospital. A 58 years old male with arterial hypertension suffered from orchiepididymitis. CT scan showed a tumor of the left kidney with propagation of tumorous masses to inferior vena cava and pulmonary artery. In elective surgery the vascular surgeon and cardiothoracic surgeon successfully performed left radical nephrectomy with total thromboembolectomy of the tumorous masses from inferior vena cava and pulmonary artery. After surgery a temporary paralytic ileus and an episode of atrial fibrillation occurred. Both are common postoperative complications related to the given surgical procedure. Follow-up CT scan showed no residual tumor or thrombus in inferior vena cava and pulmonary artery. Echocardiography revealed persistent dilation of right compartments of the heart with good systolic functions of both ventricles. The patient was discharged from hospital in a good condition. Conclusion: Surgical removal of renal tumor and tumor thrombus – radical nephrectomy with tumor thrombectomy – can be a curative treatment and can ensure long-term survival of the patient. Depending on the extent of the tumor thrombus, these operations can be performed in different ways – mini-invasive, robotic or open. When open surgery is used, it is possible to perform the procedure with or without extracorporeal circulation (cardiopulmonary bypass – CPB) depending on the extent of the disease.

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