Renal-cell carcinoma with intracaval neoplastic extension: stratification and surgical technique

Abstract

Surgical removal continues to be the mainstay in the treatment of renal-cell carcinoma with neoplastic venous extension. The steady improvement of surgical and anesthesiological techniques and the introduction of complete circulatory arrest has dramatically improved the morbidity even of patients with extensive thrombi. If ultrasound or computerized tomography (CT) scanning suggests the presence of a venous extension in a patient with renal-cell carcinoma, cavography, magnetic resonance imaging (MRI), transesophageal color-coded ultrasound, and echocardiography may be needed to resolve the questions of cranial extension and vascular wall infiltration. Surgical stratification and, thus, classification of the venous extension depend on the potential need for complete circulatory arrest. Surgical removal is done en bloc for smaller venous extensions and in a two-step procedure (radical nephrectomy followed by thrombectomy) for more extensive thrombi. In patients with infiltration of the suprahepatic inferior vena cava, the hepatic veins or atrium, pending thrombotic embolism, or large masses of suprahepatic thrombotic material, the use of cardiopulmonary bypass and complete circulatory arrest is recommended.

Prognostic relevance of intracaval neoplastic extension for patients with renal cell cancer

“…The operative strategy carried out in Patients with intracaval neoplastic extension our clinic has been detailed previously [12]. When the cranial margin of the VCT is below the hepatic vein This group comprised 53 patients (41 men and 12 women, mean age 60 years, range 35-79) followed for junction, the IVC can be cleared after simple clamping.…”

Recurrence of Renal Cell Carcinoma with Extensive Vena Caval Thrombus Three Years after Radical Nephrectomy

“…However, surgical excision of vena caval thrombus is technically challenging especially when tumor extension is above the hepatic veins. This is due to the use of cardiopulmonary bypass, deep hypothermia, and circulatory arrest that might be required [2,[4][5][6]. We report an unusual timing of a recurrence of RCC thrombus extending from the renal vein stump to the right ventricle three years after a radical nephrectomy.…”

Tumour nephrectomy with vena cava thrombus

“…From the practical standpoint of an optimal use of human and equipment resources, the most important question before surgery in patients with renal tumours and neoplastic extension into the inferior vena cava is whether or not the individual case can be safely managed with no need for a cardiopulmonary bypass [12]. These situations/instances include small intracaval protrusions and larger intracaval thrombi with a definitive infrahepatic cranial margin (Type 1; Table 1; Fig.…”