scholarly journals 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

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.

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

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.  

scholarly journals En Bloc Resection of Right Renal Cell Carcinoma and Inferior Vena Cava with Tumor Thrombus: Is It Safe to Divide the Left Renal Vein?

2021 ◽  
Author(s):  
Laura Horodyski ◽  
Javier Gonzalez ◽  
Marina M. Tabbara ◽  
Jeffrey J. Gaynor ◽  
Maria Rodriguez-Cabero ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Inferior Vena Cava ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Tumor Thrombus ◽  
Inferior Vena ◽  
Vena Cava ◽  
Level Ii

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.

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

2019 ◽  
Vol 13 (3) ◽  
pp. 155798831984640 ◽  
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

Solitary Massive Right Ventricular Metastasis of Renal Cell Carcinoma Without Inferior Vena Cava or Right Atrium Involvement

2006 ◽  
Vol 21 (3) ◽  
pp. 304-306 ◽  
Author(s):  
Fernando A. Atik ◽  
Jose L. Navia ◽  
Venkatesh Krishnamurthi ◽  
Gurmeet Singh ◽  
Takahiro Shiota ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Inferior Vena Cava ◽  
Right Ventricular ◽  
Cell Carcinoma ◽  
Right Atrium ◽  
Renal Cell ◽  
Inferior Vena ◽  
Vena Cava

scholarly journals Sonographic Evaluation of Inferior Vena Cava Tumor Thrombus in Renal Cell Carcinoma: A Case Study of a Rare Condition

2018 ◽  
Vol 34 (5) ◽  
pp. 375-382
Author(s):  
Viyana Hamblen
Keyword(s):  
Renal Cell Carcinoma ◽  
Inferior Vena Cava ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Tumor Thrombus ◽  
Inferior Vena ◽  
Wilms Tumor ◽  
Circulatory Arrest ◽  
Vena Cava ◽  
Ivc Tumor

Inferior vena cava (IVC) tumor thrombus in renal cell carcinoma is a rare entity that suggests heightened biologic behavior and a surgical challenge during the course of treatment. Tumor thrombus can extend from the renal vein to the right atrium. This cephalad extension is classified by four different levels. These levels determine which surgical approach is used, whether a thoracoabdominal incision is needed, and whether a patient needs to be placed in circulatory arrest. Complete surgical resection of the tumor is potentially the only curative treatment, although it supposes a challenge because of operative difficulty and the potential for massive bleeding or tumor pulmonary thromboembolism. IVC tumor thrombus presents with a few differentials that need to be assessed, including bland thrombus, primary IVC leiomyosarcoma, hepatocellular carcinoma, adrenal cortical carcinoma, primary lung carcinoma, and Wilms tumor. The importance of diagnosing IVC tumor thrombus secondary to renal cell carcinoma is demonstrated as well as a sonographic protocol for assessing IVC tumor thrombus.

scholarly journals Role of presurgical targeted molecular therapy in renal cell carcinoma with an inferior vena cava tumor thrombus

2018 ◽  
Vol Volume 11 ◽  
pp. 1997-2005 ◽  
Author(s):  
Cheng Peng ◽  
Liangyou Gu ◽  
Lei Wang ◽  
Qingbo Huang ◽  
Baojun Wang ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Inferior Vena Cava ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Tumor Thrombus ◽  
Inferior Vena ◽  
Vena Cava ◽  
Molecular Therapy ◽  
Targeted Molecular Therapy
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