Supradiaphragmatic Renal Cell Carcinoma Tumor Thrombus: Indications for Vena Caval Reconstruction With Pericardium

Abstract

Supradiaphragmatic extension of tumor thrombus from a renal cell carcinoma presents a major surgical challenge. The use of cardiopulmonary bypass, hypothermia and cardiac arrest with temporary exsanguination has allowed for successful surgical excision of these tumors. A renal cell carcinoma on the right side with a supradiaphragmatic tumor thrombus still may only partially occlude the vena cava. The collateral venous circulation of the left renal vein may be developed poorly and a pericardial patch can allow successful reconstruction of the inferior vena cava. If the tumor arises on the left side continued venous drainage of the right kidney is mandatory to prevent venous infarction of the right kidney. The entire vena cava also might be reconstructed theoretically with pericardium.

Surgical treatment of renal cell carcinoma with extension into the vena cava

“…In addition, thrombosis may occur if the lumen of the vena cava is decreased to less than 50°70 of its normal diameter. As detailed in previous studies, the pericardium provides an excellent autologous material for vena cava reconstruction [8].…”

Surgical Management and Outcome of Renal Cell Carcinoma with Inferior Vena Cava Tumor Thrombus

“…Since the 1970s, the conventional treatment of renal carcinomas with IVC thrombi has been radical nephrectomy accompanied with tumor thrombectomy. Since then, the data of several studies have demonstrated that long-term survival with these tumors could be achieved by this surgical procedure [4,5] . When the thrombus is localized below the hepatic veins, tumor thrombus removal could be performed with control of the IVC above and below the level of the thrombus.…”

“…The survival rate of patients with tumor thrombus in the IVC was better when the patients underwent a combined nephrectomy and tumor thrombectomy compared to those with nephrectomy and medical treatment without thrombectomy. The results of medical therapy were limited when the tumor thrombus was not removed [4,5] .…”

Total Replacement of the Aorta and the Inferior Vena cava after Resection of an Extra-Adrenal Malignant Pheochromocytoma

“…The venous graft clearly has lower patency rates than arterial reconstructions because of the low-pressure, low-flow venous system. Some reports have used pericardium for vena caval reconstruction, because autologous material was less likely to thrombose [5]. In some examination of dogs, autologous pericardium was the better material for patch grafts in reconstruction of the IVC than biografts and synthetic grafts [6]; however, there wasn't a suitable sized autologous graft for the total replacement of the inferior vena cava.…”