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