IntroductionInferior vena cava tumor thrombectomy in renal cell carcinoma patients is a challenging procedure, frequently requiring the vascular bypass technique for high-level thrombi with additional complications. Adopting a technique such as intrapericardial control in selected cases will circumvent these problems. Here, we present the results of our intrapericardial control technique during supradiaphragmatic inferior vena caval tumor thrombectomy.Case PresentationThe records of six patients with supradiaphragmatic tumor thrombi, who underwent radical nephrectomy and thrombectomy at our center with intrapericardial control between the years 2008 and 2015, were retrospectively reviewed. The patients’ characteristics, intra- and postoperative data, histology, and follow-up records were gathered and compared. There were no immediate or 30-day postoperative deaths. The mean age of the patients was 61.3 years (range 46 - 75). The total mean duration of surgery was 315 minutes and the mean amount of transfused red blood cells was 4.33 units during surgery and 0.8 units in the postoperative period. The average hospitalization duration was 8 days (range 5 - 17). Tumor stage was T3 in four patients and T4 in two, due to ipsilateral adrenal involvement. The mean duration of follow-up was 33.5 months. Only one of the patients developed recurrences, first in the tumor bed and then at the site of the skin incision; these were excised with no apparent complications.ConclusionsRadical nephrectomy and tumor thrombectomy by intrapericardial control without cardiopulmonary bypass and hypothermic circulatory arrest is a safe and effective procedure that can avoid serious intra- and postoperative complications while providing acceptable cancer-control and mortality results.
Angiomyolipoma (AML) is the most common benign renal mesenchymal neoplasm. This is a report of a 36-year-old female patient with AML with the involvement of the inferior vena cava (IVC) who was admitted to our hospital. The patient complained of mild right flank pain. CT scan results showed a hypo-dense mass with 47×72 mm dimensions at the right kidney›s lower pole suggesting renal AML. In MRI with contrast, venous thrombosis was detected in the right renal vein and IVC. Right radical nephrectomy and IVC thrombectomy were successfully conducted. Renal AML was confirmed by pathological findings, and the presence of tumor thrombosis was approved in the right renal vein and IVC. Although AML is generally benign and vascular invasion is a rare finding in this condition, imaging studies (including CT scans) should always be considered to determine the extent of vascular involvement and choose an appropriate therapeutic plan, including nephrectomy and thrombectomy in case of vascular involvement. Despite its benign nature, it should be considered that AML can invade venous structures in the kidneys. Early imaging studies and therapeutic interventions are necessary for obtaining the best outcome.
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