TY - JOUR
T1 - Multidisciplinary surgical approach for renal cell carcinoma with inferior vena cava tumor thrombus
AU - Yano, Daisuke
AU - Yokoyama, Yukihiro
AU - Tokuda, Yoshiyuki
AU - Kato, Masashi
AU - Mashiko, Yuji
AU - Kuwabara, Fumiaki
AU - Ebata, Tomoki
AU - Usui, Akihiko
N1 - Publisher Copyright:
© 2021, The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.
PY - 2022/7
Y1 - 2022/7
N2 - Purposes: The optimal surgical management of renal cell carcinoma with tumor thrombus within the inferior vena cava (IVC) remains to be clarified. Methods: Sixteen consecutive cases were reviewed. Incision, the IVC clamping position, and the venous drainage procedure were modified according to the tumor thrombus extension level: level I or II (below the hepatic vein, n = 8), level III (above the hepatic vein but below the right atrium, n = 5), and level IV (extending into the right atrium, n = 3). Results: For level I or II, resection could be simply achieved by clamping the IVC below the hepatic vein, without hemodynamic collapse. For level III, clamping the IVC above the hepatic vein and the hepatoduodenal ligament was required. Venous drainage from the lower body (cannulation to distal IVC) and portal system (cannulation to ileocolic vein) were applied. When opening the IVC, the significant backflow was controlled using cardiopulmonary bypass with drop-in suckers. For level IV, median sternotomy, exposure of the right atrium, and cardiopulmonary bypass were mandatory. With the combination of these approaches, the perioperative mortality rate was 0% and the 5-year overall survival rate was 52%. Conclusions: A multidisciplinary surgical approach is essential, especially for level III and IV cases.
AB - Purposes: The optimal surgical management of renal cell carcinoma with tumor thrombus within the inferior vena cava (IVC) remains to be clarified. Methods: Sixteen consecutive cases were reviewed. Incision, the IVC clamping position, and the venous drainage procedure were modified according to the tumor thrombus extension level: level I or II (below the hepatic vein, n = 8), level III (above the hepatic vein but below the right atrium, n = 5), and level IV (extending into the right atrium, n = 3). Results: For level I or II, resection could be simply achieved by clamping the IVC below the hepatic vein, without hemodynamic collapse. For level III, clamping the IVC above the hepatic vein and the hepatoduodenal ligament was required. Venous drainage from the lower body (cannulation to distal IVC) and portal system (cannulation to ileocolic vein) were applied. When opening the IVC, the significant backflow was controlled using cardiopulmonary bypass with drop-in suckers. For level IV, median sternotomy, exposure of the right atrium, and cardiopulmonary bypass were mandatory. With the combination of these approaches, the perioperative mortality rate was 0% and the 5-year overall survival rate was 52%. Conclusions: A multidisciplinary surgical approach is essential, especially for level III and IV cases.
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U2 - 10.1007/s00595-021-02415-1
DO - 10.1007/s00595-021-02415-1
M3 - Article
C2 - 34786640
AN - SCOPUS:85119080792
SN - 0941-1291
VL - 52
SP - 1016
EP - 1022
JO - Surgery Today
JF - Surgery Today
IS - 7
ER -