Temporary Filters and Liver Mobilization Technique Improve the Safety and Prognosis of Radical Nephrectomy and Inferior Vena Cava Thrombectomy in Renal Cell Carcinoma with Subdiaphragmatic Thrombosis

Abstract

Aims: This study aimed to investigate the safety and efficacy of preoperative temporary inferior vena cava (IVC) filter placement and intraoperative application of a liver mobilization technique. Materials and Methods: The experiment cohort of 42 cases and the control cohort of 36 cases of renal cell carcinoma involving the IVC were analyzed retrospectively. In the experiment cohort, patients were implanted with a temporary IVC filter as routine preoperative treatment. The control cohort of 36 cases received traditional radical nephrectomy + IVC thrombectomy. Results: In the experiment cohort, 42 cases did not show any symptom of tumor thrombus embolism perioperatively. The average operation time was 220 min and the average blood loss was 750 ml. Overall survival rate of improved surgery was significantly higher than traditional surgery (p = 0.0055). Moreover, tumor thrombus size and position was associated with overall survival (p = 0.0185). Conclusions: Preoperative temporary IVC filter placement and intraoperative application ofaliver mobilization technique to expose the IVC can effectively prevent tumor thrombosis embolism shedding and improve surgical safety.

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

“…However, a majority of authors found that the tumorspecific survival was worse in higher tumor thrombus levels [18][19][20][21] . Ciancio et al [19] reported that the 5-year tumor specific survival was 71, 48, 40, and 35% for IVC thrombus levels I, II, III, and IV, respectively.…”

“…Some authors reported that new distant metastases developed approximately in 40% of the patients with IVC tumor thrombi during the follow-up period [6,21] . Ifeoma et al [1] found distant metastases in 29% of their cases after surgery, most commonly in the lungs.…”

The role of transesophageal echocardiography in the management of renal cell carcinoma with venous tumor thrombus

“…Level 3 tumor thrombi represent a relatively heterogeneous entity and necessitate precise characterization on preoperative imaging and intraoperative TEE. Although it is possible to obtain control of the suprahepatic IVC, mobilization of the liver using liver transplant maneuvers may be necessary . Utilizing the Pringle maneuver to obtain temporary occlusion of the portal venous and arterial inflow of the liver prevents hepatic congestion and decreases blood loss while the hepatic veins are clamped .…”

“…Although it is possible to obtain control of the suprahepatic IVC, mobilization of the liver using liver transplant maneuvers may be necessary. 27,28 Utilizing the Pringle maneuver to obtain temporary occlusion of the portal venous and arterial inflow of the liver prevents hepatic congestion and decreases blood loss while the hepatic veins are clamped. 27,29 If the tumor thrombus can be milked down below the hepatic venous confluence, however, a tourniquet may be applied to the IVC below the hepatic venous outflow, thereby avoiding liver congestion.…”

Intraoperative Cardiogenic Shock Caused by Intracardiac Tumor Thrombi Obstruction

“…For complete removal of advanced tumor thrombi, TEE guidance was indispensable in our patient. For RCC with advanced IVC invasion, a temporary IVC filter may be considered to prevent dangerous tumor thrombus migration [4].…”