Surgical technique for the treatment of renal cell carcinoma with inferior vena cava tumor thrombus: tips, tricks and oncological results

Abstract

Renal cell carcinoma represents 3 % of all cancers. Around 4–10 % of cases present with inferior vena cava involvement, generally with tumor thrombus. Clinical and preoperative stage will be classified depending of the thrombus extension. A high quality preoperative workup is essential to properly plan surgical approach. Complete surgical resection of the tumor is potentially the only curative treatment, although it supposes a real challenge due to operative difficulty, potential for massive bleeding or tumor pulmonary thromboembolism. Surgery includes techniques derived from transplantation surgery and, in some cases, cardiovascular intervention with cardiopulmonary bypass. Long-term oncological outcomes after complete removal of the entire tumor burden are acceptable. In this report we describe step-by-step surgical maneuvers depending on the thrombus lever, and focusing in complete abdominal approach for the complete excision of the tumor. Moreover, a recent literature review about oncological results is reported.

Renal cell carcinoma, complicated by thrombosis of the inferior vena cava and the right atrium

“…Vital Hevia, Gaetano Ciancio, Victoria Gomez [39] ïðîïîíóþòü ìîäèô³êîâàíó êëàñèô³-êàö³þ ïîøèðåííÿ ïóõëèííèõ òðîìá³â III ð³âíÿ: -гâåíü I -òðîìá îáìåaeåíèé íèðêîâîþ âåíîþ; -гâåíü II -òðîìá ó ï³äïå÷³íêîâîìó ñåãìåíò³ ÍÏÂ; -гâåíü III -òðîìá ó ðåòðîïå÷³íêîâîìó ñåãìåíò³ ÍÏÂ; -гâåíü IIIa -òðîìá ó ðåòðîïå÷³íêîâîìó ñåãìåíò³ ÍÏÂ, íèae÷å ãîëîâíèõ ïå÷³íêîâèõ âåí; -гâåíü IIIb -òðîìá ó ðåòðîïå÷³íêîâîìó ñåãìåíò³ ÍÏÂ, àëå äîñÿãຠóñòÿ ãîëîâíèõ ïå÷³íêîâèõ âåí; -гâåíü IIIñ -òðîìá ó ðåòðîïå÷³íêîâîìó ñåãìåíò³ ÍÏ ³ ïîøèðþºòüñÿ íàä ãîëîâíèìè ïå÷³íêîâèìè âåíàìè, àëå íèae÷å ä³àôðàãìè; -гâåíü IIId -òðîìá ó íàäïå÷³íêîâîìó ³ íàää³àôðàãìàëüíîìó ñåãìåíò³ ÍÏÂ, äîñÿãຠ³íòðàïå-ðèêàðä³àëüíîãî â³ää³ëó ÍÏÂ, àëå íèae÷å ïåðåäñåðäÿ (ïîçà ïðàâèìè â³ää³ëàìè ñåðöÿ); -гâåíü IV -ïðàâå ïåðåäñåðäÿ.…”

Diagnosis and surgical treatment of renal cell carcinoma with supradiaphragmatic level invasion of the inferior vena cava

“…Ñåðéîçíèì òåõí³÷íèì çàâäàííÿì º êîíòðîëü âåðõ³âêè ïóõëèííîãî òðîìáó ïðè éîãî íàää³àôðà´ìàëü-í³é ëîêàë³çàö³¿. Òðàäèö³éíî ó äàíî¿ êàòå´î𳿠õâîðèõ âèêîðèñòîâóþòü òåõíîëî´³¿ øòó÷íîãî êðîâîîá³ãó [2,5,6,7]. Çà îñòàíí³ ðîêè âñå ÷àñ-ò³øå ïîâ³äîìëÿþòü ïðî àëüòåðíàòèâí³ õ³ðóð-³÷í³ ï³äõîäè äî ñóïðàä³àôðà´ìàëüíîãî â³ää³ëó ÍÏ âèêëþ÷íî ç áîêó ÷åðåâíî¿ ïîðîaeíèíè [2,4,7].…”

“…Òðàäèö³éíî ó äàíî¿ êàòå´î𳿠õâîðèõ âèêîðèñòîâóþòü òåõíîëî´³¿ øòó÷íîãî êðîâîîá³ãó [2,5,6,7]. Çà îñòàíí³ ðîêè âñå ÷àñ-ò³øå ïîâ³äîìëÿþòü ïðî àëüòåðíàòèâí³ õ³ðóð-³÷í³ ï³äõîäè äî ñóïðàä³àôðà´ìàëüíîãî â³ää³ëó ÍÏ âèêëþ÷íî ç áîêó ÷åðåâíî¿ ïîðîaeíèíè [2,4,7]. Âîäíî÷àñ, âèäàëåííÿ ïóõëèííîãî òðîìáó òðàíñä³àôðà´ìàëüíèì äîñòóïîì ìîaeå ïðèçâåñòè äî éîãî ôðà´ìåíòàö³¿ ç ðîçâèòêîì ìàñèâíî¿ òðîìáîåìáî볿 ëåãåíåâî¿ àðòå𳿠(ÒÅËÀ).…”

Xeno‐pericardial patch repair of the inferior vena cava for radical resection of renal cell carcinoma with tumor thrombus

“…In the supine position under general anesthesia, firstly, the hepatobiliary team exposed the intrahepatic IVC with the right side liver mobilization by the "piggy-back" liver detachment technique, before the right, the middle, and the left hepatic veins were dissected with vessel loops placed. 12,13 Median sternotomy prior to the liver mobilization helped the exposure in the Case 6 and 7. In addition, the hepatoduodenal ligament was encircled with a vessel tape to permit the Pringle maneuver.…”