Modified Vein Clamping Technique for Renal Cell Carcinoma Complicated With Level I-II IVC Thrombus: A Study At A Single Center

Objectives To share our initial experience with modified vein clamping technique for the treatment of renal cell carcinoma complicated with the level I-II IVC thrombus Methods From March 2018 to April 2021, 11 patients with renal cell carcinoma (RCC) involving the IVC tumor thrombus were admitted to our hospital. Then, they all underwent laparoscopic radical nephrectomy and IVC thrombectomy (LRN-IVCTE) using modified vein clamping technique. Results All procedures were successfully completed without conversion to open surgery. The median operative time was 185 min (range 125–229 min); the median estimated blood loss was 200 ml (range 150–300 ml), and four patients received an intraoperative transfusion. Besides, the median IVC clamping time was 18 min (range 10–24 min); the median postoperative hospital stay was 6 days (range 4–8 days), while the median follow-up period was 28 months (range 2–36 months). Conclusions Modified vein clamping technique for the treatment of renal cell carcinoma complicated with the level I-II IVC thrombus may be a safe and technically feasible alternative technic.

A modified surgical technique of shortening renal ischemia time in left renal cancer patients with Mayo level II-IV tumor thrombus

Background To explore the safety and effectiveness of a modified surgical technique which could shorten the time of renal ischemia in left renal cancer and Mayo level II to IV inferior vena cava (IVC) tumor thrombusMethod We retrospectively analyzed the clinical data of 14 cases with left renal cell carcinoma (RCC) and Mayo level II to IV IVC tumor thrombus from February 2015 to July 2019. Preoperative imaging showed that there was no obvious sign of tumor thrombus invading the blood vessel wall. During the surgery, after the right renal artery, the right renal vein and the distal end of IVC were blocked, the balloon catheter was used and the tumor thrombus was removed completely from the IVC. The incision of IVC was closed by Satinsky clamp to make IVC partially blocked. Then the right renal artery and right renal vein were released. The incision of IVC was sutured continuously. At last, the Satinsky clamp and the blocking band at the distal end of the IVC were released.Result There were 8 cases (57.1%) of Mayo level II, 3 cases (21.4%) of Mayo level III and 3 cases (21.4%) of Mayo level IV. The operation was successfully completed in all 14 patients. There were 2 cases (14.3%) operated by complete laparoscopic approach, 8 cases (57.1%) by open approach, and 4 patients (28.6%) by laparoscopic conversion to open approach. The occlusion time of right renal artery and vein (renal ischemia time) was 3 to 15 minutes, with an average of (6.8 ±3.2) minutes. The mean time of IVC occlusion was (19.4 ±4.9) min. Preoperative creatinine was 66 to 130 μmol/L, with an average of (96.6 ±21.2) μmol/L. One week after operation, serum creatinine was 64 to 632 μmol/L, with an average of (132.4 ±144.9) μmol/L. Among the 14 cases, 5 (42.9%) had early postoperative complications. Besides one of the 14 patients died in perioperative period, the median follow-up of other 13 cases was 10 months (range: 4-29 months). The 5 (35.7%) of the 14 cases were died of disease.Conclusion This modified procedure was relatively safe and effective in shortening the time of renal ischemia in left RCC patients with Mayo II to IV IVC tumor thrombus.

A modified surgical technique of shortening renal ischemia time in left renal cancer patients with Mayo level II-IV tumor thrombus

Background to explore the safety and effectiveness of a modified surgical technique which could shorten the time of renal ischemia in left renal cancer and Mayo level II to IV inferior vena cava (IVC) tumor thrombusMethod We retrospectively analyzed the clinical data of 14 cases with left renal cell carcinoma (RCC) and Mayo level II to IV IVC tumor thrombus from February 2015 to July 2019. Preoperative imaging showed that there was no obvious sign of tumor thrombus invading the blood vessel wall. During the surgery, after the right renal artery, the right renal vein and the distal end of IVC were blocked, the balloon catheter was used and the tumor thrombus was removed completely from the IVC. The incision of IVC was closed by Satinsky clamp to make IVC partially blocked. Then the right renal artery and right renal vein were released. The incision of IVC was sutured continuously. At last, the Satinsky clamp and the blocking band at the distal end of the IVC were released.Result There were 8 cases (57.1%) of Mayo level II, 3 cases (21.4%) of Mayo level III and 3 cases (21.4%) of Mayo level IV. The operation was successfully completed in all 14 patients. There were 2 cases (14.3%) operated by complete laparoscopic approach, 8 cases (57.1%) by open approach, and 4 patients (28.6%) by laparoscopic conversion to open approach. The occlusion time of right renal artery and vein (renal ischemia time) was 3 to 15 minutes, with an average of (6.8±3.2) minutes. The mean time of IVC occlusion was (19.4±4.9) min. Preoperative creatinine was 66 to 130 μmol/L, with an average of (96.6 ± 21.2) μmol/L. One week after operation, serum creatinine was 64 to 632 μmol/L, with an average of (132.4 ± 144.9) μmol/L. Among the 14 cases, 5 (42.9%) had early postoperative complications. Besides one of the 14 patients died in perioperative period, the median follow-up of other 13 cases was 10 months (range: 4-29 months). The 5 (35.7%) of the 14 cases were died of disease.Conclusion This modified procedure was relatively safe and effective in shortening the time of renal ischemia in left RCC patients with Mayo II to IV IVC tumor thrombus.

A modified surgical technique of shortening renal ischemia time in left renal cancer patients with Mayo level II-IV tumor thrombus

Objective to explore the safety and effectiveness of a modified surgical technique which could shorten the time of renal ischemia in left renal cancer and Mayo level II to IV inferior vena cava (IVC) tumor thrombusMethod We retrospectively analyzed the clinical data of 14 cases with left renal cell carcinoma (RCC) and Mayo level II to IV IVC tumor thrombus. Preoperative imaging showed that there was no obvious sign of tumor thrombus invading the blood vessel wall. During the surgery, after the right renal artery, the right renal vein and the distal end of IVC were blocked, the balloon catheter was used and the tumor thrombus was removed completely from the IVC. The incision of IVC was closed by Satinsky clamp to make IVC partially blocked. Then the right renal artery and right renal vein were released. The incision of IVC was sutured continuously. At last, the Satinsky clamp and the blocking band at the distal end of the IVC were released.Result There were 8 cases (57.1%) of Mayo level II, 3 cases (21.4%) of Mayo level III and 3 cases (21.4%) of Mayo level IV. The operation was successfully completed in all 14 patients. There were 2 cases (14.3%) operated by complete laparoscopic approach, 8 cases (57.1%) by open approach, and 4 patients (28.6%) by laparoscopic conversion to open approach. The occlusion time of right renal artery and vein (renal ischemia time) was 3 to 15 minutes, with an average of (6.8±3.2) minutes. The mean time of IVC occlusion was (19.4±4.9) min. Preoperative creatinine was 66 to 130 μmol/L, with an average of (96.6 ± 21.2) μmol/L. One week after operation, serum creatinine was 64 to 632 μmol/L, with an average of (132.4 ± 144.9) μmol/L. Among the 14 cases, 5 (42.9%) had early postoperative complications. Besides one of the 14 patients died in perioperative period, the median follow-up of other 13 cases was 10 months (range: 4-29 months). The 5 (35.7%) of the 14 cases were died of disease.Conclusion This modified procedure was relatively safe and effective in shortening the time of renal ischemia in left RCC patients with Mayo II to IV IVC tumor thrombus.

Simultaneous Cesarean Section and Radical Nephrectomy With Tumor Thrombectomy During Pregnancy

Abstract- Renal cell carcinoma (RCC) is uncommon during pregnancy. Accurate and timely diagnosis and careful preoperative planning are essential to optimize the patient outcomes. A 27-year-old pregnant woman presented with a large mass in left kidney and inferior vena cava (IVC) tumor thrombus, diagnosed at 33 weeks gestation. She was evaluated with an initial impression of pyelonephritis at other institutions and referred to our center after a delay of more than 3 weeks. RCC with IVC tumor thrombus has the potential to increase the likelihood of thromboembolic events including pulmonary embolism during pregnancy. Furthermore, simultaneous radical nephrectomy with IVC thrombectomy and Cesarean section (CS) is challenging and might be associated with significant intraoperative blood loss. After consultation with an obstetrician and cardiac surgery team, our patient underwent CS and simultaneous left radical nephrectomy with IVC thrombectomy at 34 weeks gestation. The postoperative course was uneventful and histologic analysis revealed pT3bN0M0 papillary RCC.