Renal tumor with tumor thrombus in inferior vena cava and right atrium: the report of five cases with long-term follow-up

Abstract

Patients with RCC and the extension of TT in IVC and right atrium need a multidisciplinary surgical strategy. Atrial and caval tumor thrombectomy can be performed safely and effectively, with a low complication rate, using normothermic CPB. Long-term results are promising; however, larger prospective multicentre studies are necessary.

Modified technique of cavoatrial tumor thrombectomy without cardiopulmonary by-pass and hypothermic circulatory arrest: a preliminary report

“…Although considerable, our total mean operative blood loss is comparable with or better than the blood loss and transfusion requirements reported in other studies which analyzed surgical outcomes after conventional or minimally invasive interventions for level III or IV TT [ 22 , 25 , 27 , 28 ]. In their series, Radak et al [ 27 ] presented the perioperative outcomes of five radical nephrectomies with atrial thrombectomy with the use of a normothermic cardiopulmonary bypass. Although they did not report the mean blood loss, the average number of packed cells transfusions was 12.…”

Reply to: “The minimal access technique for cavoatrial renal cancer thrombectomy – to be used in all cases?”

“…It was attributed to collateral veins around the kidney and occurred predominantly before cavotomy and tumor thrombus retrieval. Our data on the mean blood loss are indeed comparable or better than the blood loss and transfusion requirements reported in other studies, which analysed surgical outcomes after conventional or minimally invasive interventions for level IV TT [ 2 , 4 , 5 ]. This, however, should not be compared with the results presented in two papers called by authors of the commentary for the three main reasons [ 6 , 7 ].…”

Blood Loss and Massive Transfusion in Patients Undergoing Major Oncological Surgery: What Do We Know?

“…Reported estimated blood loss [38][39][40][41][42][43] 400-12,100 2-10 Sacral tumors [44][45][46] 3,000-37,000 0-43 Hemipelvectomy [47][48][49][50] 400-12,100 0-134 Total pelvic exenterations [47][48][49][50] 900-9,500 0-18 Nephrectomy with IVC embolectomy [37,[51][52][53][54][55] 200−16,000 0−91 Liver and multivisceral resection [12,[56][57][58][59][60][61][62] 200->5,000 0-44 Extrapleural pneumonectomies [63][64][65] 900-65,00 0-18 Table 1 illustrates ranges of blood losses and PRBCs of transfused units reported in the literature.…”

“…ranges from 200 cc to 16,000 cc and mainly depends on the patient's age, tumor size, the level of vascular invasiveness, and factors inherent to the surgical procedures itself such as total versus partial nephrectomy, duration of surgery, preoperative renal artery embolization, use of traditional or minimal invasive cardiopulmonary bypass, and surgeon experience [36,37,[51][52][53][54][66][67][68]. Two observational studies demonstrated an increased rate of blood loss in patients with a level III or IV caval tumor thrombus, and in whom cardiopulmonary bypass with or without hypothermic arrest was used during the thrombectomy [69,70].…”

“…Fifty to 100 percent of the patients undergoing radical nephrectomies followed by IVC thrombectomy are transfused with packed red cell (PRBCs) [68,71]; however, the exact incidence of patients having massive blood transfusion is unknown. The reported number of PRBC units transfused varies significantly (from 0 to 91), as does the time period over which the transfusions are administered in the perioperative period [37,[51][52][53][54][55] (Table 1). This is due to the fact that some authors have reported "perioperative" blood transfusions without clear specifications about timing parameters, while others have only published the number of units administered during the intraoperative and postoperative periods or during intensive care unit admission.…”