Surgical strategy for treating renal cell carcinoma with thrombus extending into the inferior vena cava

Jibiki, Masatoshi; Iwai, Takehisa; Inoue, Yasuhiro; Sugano, Norihide; Kihara, Kazunori; Hyochi, Nobuhiko; Sunamori, Makoto

doi:10.1016/j.jvs.2003.12.004

Cited by 101 publications

(85 citation statements)

References 21 publications

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“…Renal cell carcinomas (RCCs) have a tendency to invade the venous system: first into the renal vein and then advancing into the inferior venous cava (IVC) as the disease progresses. RCC extension into the IVC has been reported in between 4% and 19% of the patients [32,33]. According to the extent of their invasion into the IVC system, these tumors are classified into 4 categories, level I: tumor thrombus extending in the renal vein or for less than 2 cm into the infrahepatic segment of the IVC; level II: tumor thrombus extending into the IVC to below the hepatic vein; level III: tumor thrombus extending into the suprahepatic segment of the vena cava; level IV: those progressing into the right atrium [34].…”

Section: Nephrectomy With Inferior Venous Cava Thrombectomymentioning

confidence: 99%

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

Cata

Gottumukkala

2012

ISRN Anesthesiology

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Patients with solid malignancies who were not candidates for tumor resections in the past are now presenting for extensive oncological resections. Cancer patients are at risk for thromboembolic complications due to an underlying hypercoagulable state; however, some patients may have an increased risk for bleeding due to the effects of chemotherapy, the administration of anticoagulant drugs, tumor-related fibrinolysis, tumor location, tumor vascularity, and extent of disease. A common potential complication of all complex oncological surgeries is massive intra-and postoperative hemorrhage and the subsequent risk for massive blood transfusion. This can be anticipated or unexpected. Several surgical and anesthesia interventions including preoperative tumor embolization, major vessel occlusion, hemodynamic manipulation, and perioperative antifibrinolytic therapy have been used to prevent or control blood loss with varying success. The exact incidence of massive blood transfusion in oncological surgery is largely unknown and/or underreported. The current literature mostly consists of purely descriptive observational studies. Thus, recommendation regarding specific perioperative intervention cannot be made at this point, and more research is warranted.

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Section: Nephrectomy With Inferior Venous Cava Thrombectomymentioning

confidence: 99%

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

Cata

Gottumukkala

2012

ISRN Anesthesiology

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“…Медиана диа-метра первичной опухоли составила 11 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) см. Ка-тегория T оценена как T3b в 31 (63,3 %), T3c -в 15 (30,6 %) и T4 -в 3 (6,1 %) случаях.…”

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“…При этом сохраняется коллатеральный отток крови от левой почки, и снижение почечной функции не раз-вивается [14]. В нашей серии наблюдений ни у одного из 24 больных, подвергнутых перевязке левой ПВ, ухудшения почечной функции не зарегистрировано.…”

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Surgical treatment of renal cell carcinoma with advanced tumor invasion of the inferior vena cava

Давыдов¹,

Матвеев²,

Волкова³

et al. 2017

Cancer Urology

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“…En 2002, 18.700 nuevos casos fueron diagnosticados en Estados Unidos con 7500 muertes debidos al carcinoma renal de células claras 1 . Entre el 4 y 15% de estos tumores tienen trombo tumoral asociado en la vena renal o en la vena cava inferior (VCI) y el tipo histológico más frecuente en los tumores con trombo tumoral asociado es el Carcinoma de Células Renales (CCR) [5][6][7][8][9] .…”

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Tumor renal con trombo en la vena cava inferior: Manejo quirúrgico y pronóstico

et al. 2009

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ResumenObjetivos: el objetivo del presente estudio fue evaluar las estrategias usadas para el manejo quirúrgico del cáncer de renal con extensión de trombo a la vena cava inferior y evaluar el pronóstico del paciente. Métodos: Quince pacientes con cáncer renal y trombo en la vena cava inferior fueron sometidos a una nefrectomía radical y trombectomía y fueron evaluados de forma retrospectiva. Los pacientes fueron seguidos desde 0 a 36 meses (media de 9,5 meses). La tomografía computada con reconstrucción tridimensional fue usada para definir el nivel del trombo. Resultados: La edad media fue de 54 años, con un rango de entre 16 y 79 años. El trombo fue clasificado como de nivel I (13,5%), nivel II (40%), nivel III (26,5%) y nivel IV (20%). La cirugía fue llevada a cabo mediante by pass cardiopulmonar en seis casos, tres de los cuales sin esternotomía. Hubo una muerte intraoperatoria (13%) en un paciente que presentaba enfermedad metastásica con un trombo que alcanzaba la aurícula derecha. Los pacientes con ganglios positivos o enfermedad metastásica como presentación inicial tenían peor supervivencia global en la curva de Kaplan-Meier. Ambos, estadiaje tumoral (p = 0,380), y extensión del trombo (p = 0,174) no tuvieron relación con la supervivencia. Conclusiones: A pesar de su morbilidad y mortalidad, la nefrectomía radical y la trombectomía deberían ser llevadas a cabo en casos de carcinoma renal con trombo tumoral, porque puede ofrecer la posibilidad de control local de la enfermedad. Los pacientes con ganglios linfáticos y enfermedad metastásica tienen peor pronóstico.Palabras clave: Trombo vena cava inferior. Tumor renal. Pronóstico y manejo quirúrgico. Renal tumor with inferior vena cava thrombus. Surgical approach and prognosis AbstractObjectives: The aim of this study was to evaluate strategies used for surgical management of renal cell carcinoma with tumoral thrombus extension in the inferior vena cava (IVC) and evaluate patient's prognosis. Metods: Fifteen patients with renal tumor and IVC thrombus, underwent radical nephrectomy and thrombectomy, and were retrospectively evaluated. Patients were followed for 0 to 36 months (mean of 9.5 months). Computed tomography (CT) scan with three-dimensional reconstruction was used to define IVC thrombus level. Results: The mean age was 54 years, range from 16 to 79. The thrombus was classified as level I -13.5%, level II -40%, level III -26.5% and level IV -20%. Surgery was performed with cardiopulmonary bypass (CPB) in six (40%) cases, three (50%) without sternotomy. There was one (13%) death during the intraoperative period; this patient presented extensive metastatic tumor, with the thrombus reaching the right atrium. Patients with lymph node or metastatic disease at initial presentation had poorer overall survival in Kaplan-Meier curve. Both, tumor stage (p = 0.380), and thrombus extension (p = 0.174) were not related to survival. Conclusions: Despite its morbidity and mortality, radical nephrectomy with thrombectomy should be performed in case of renal cell c...

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Surgical strategy for treating renal cell carcinoma with thrombus extending into the inferior vena cava

Cited by 101 publications

References 21 publications

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

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

Surgical treatment of renal cell carcinoma with advanced tumor invasion of the inferior vena cava

Tumor renal con trombo en la vena cava inferior: Manejo quirúrgico y pronóstico

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