Successful management of inferior vena cava and right atrial nephroblastoma tumor thrombus with preoperative chemotherapy

Abstract

Involvement of inferior vena cava (IVC) by tumor thrombus occurs in up to 10% of patients with nephroblastoma. Right atrial involvement by tumor thrombus is much less frequent. Four patients presenting with advanced nephroblastoma were diagnosed as having IVC involvement with tumor thrombus. Two of these patients had in addition thrombus extending up to the right atrium. All 4 patients were treated with preoperative chemotherapy (vincristine, actinomycin D, 4-epi-Adriamycin). Nephrectomy was subsequently performed without undue difficulty on all 4 patients. The intravascular tumor thrombus had completely cleared in all 4 patients and most of the primary renal tumor was necrotic. The results obtained with preoperative chemotherapy as given to these patients mediates strongly against difficult surgery being undertaken as primary treatment for such patients.

Wilms' tumor with intracaval thrombus in the UK Children's Cancer Study Group UKW3 trial

“…Thereafter, many authors have reported resolution of the intracaval extension of thrombus by using chemotherapy [6][7][8][9][10][11]. This approach was adopted in the third UK Children's Cancer Study Group Wilms' tumor trial, UKW3.…”

Successful treatment of intracaval and atrial extension of Wilms’ tumour by chemotherapy

“…4 formidable process, and can be associated with considerable morbidity. So if technically feasible, primary surgery may be appropriate, but in patients with dense adherence or invasion of the inferior vena cava, or when the tumour extends into the heart we recommend using pre-operative chemotherapy and/or radiation therapy (box).…”

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“…Then we perform the removal of the tissues of the kidney bed (peri-renal fat, etc.) and also perform a radical para-aortic-cava lymphadenectomy (till the level of the homo-lateral iliac vessels), considering that, according to international literature, around 5% of patients, before the use of chemotherapy, have presented lymph glands metastases [9] (Figures 6 and 7). The remaining of the kidney is repositioned, with nephropexy, followed by closure of the laparotomy in layers and leaving a drain in the renal bed, through a separate stab incision (to be kept usually for 2 days).…”