Tumour nephrectomy with vena cava thrombus

Bachmann, Alexander; Seitz, Michael; Graser, Anno; Reiser, Maximilian; Schäfers, Hans‐Joachim; Löhe, F.; Jauch, Karl‐Walter; Stief, Christian G.

doi:10.1111/j.1464-410x.2005.05496.x

Cited by 23 publications

(8 citation statements)

References 17 publications

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“…The intravascular growth observed in RCC patients could signify a heightened or more aggressive biologic behavior of the tumor. However, some authors agree that the RCC-associated tumor thrombus does not translate to a specific prognostic significance if it can be treated successfully with surgery [ 5 ]. To manage cases of RCC with IVC thrombus, several different surgical approaches such as liver transplantation [ 6 , 7 ] and thrombectomy using cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) [ 8 , 9 ] have been described.…”

Section: Introductionmentioning

confidence: 99%

Treatment of renal cell carcinoma with a level III or level IV inferior vena cava thrombus using cardiopulmonary bypass and deep hypothermic circulatory arrest

Chen

et al. 2015

World J Surg Onc

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BackgroundThe aim of this study was to investigate the minimally invasive cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) approach in the management of renal cell carcinoma (RCC) with level III or IV inferior vena cava (IVC) thrombus and evaluate the survival outcomes.MethodsWe performed a retrospective analysis on 32 RCC patients with IVC thrombus that underwent nephrectomy and thrombectomy via the minimally invasive CPB/DHCA approach between January 2007 and December 2013. Perioperative variables (for example, operative time, CPB duration, and circulatory arrest duration), estimated blood loss, hospital stay, perioperative complications, and survival data were recorded and analyzed.ResultsThirty-two patients (median age: 56 years) were treated surgically using the CPB and DHCA approach for RCC with a level III (n = 25) or level IV (n = 7) tumor thrombus. The median operation time was 360 min (interquartile range (IQR): 300 to 435 min) with median CPB and DHCA durations of 149 min and 23 min, respectively. The median estimated blood loss was 2,500 ml. Four complications were observed but no deaths occurred perioperatively. The median follow-up was 25 months (range: 4 to 64 months). The mean overall survival (OS) was 28.2 ± 4.6 months while the disease-free survival (DFS) was 19.5 ± 11.6 months. In patients with M0 disease, ten patients developed metastases and were treated with sorafenib as an adjuvant therapy. The mean OS and DFS of this subgroup were 25.4 ± 12.8 months and 16.0 ± 14.2 months, respectively.ConclusionsRadical nephrectomy and thrombectomy using CPB and DHCA to treat RCC is a relatively safe approach associated with low morbidity and mortality. This minimally invasive procedure may help minimize surgical trauma and improve perioperative outcomes.

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Section: Introductionmentioning

confidence: 99%

Treatment of renal cell carcinoma with a level III or level IV inferior vena cava thrombus using cardiopulmonary bypass and deep hypothermic circulatory arrest

Chen

et al. 2015

World J Surg Onc

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“…10 In conclusion, we can say that LRN with level II IVTT thrombectomy is a complex procedure that requires, in addition to adequate operator experience and abilities, a scrupulous preoperative patient study. Although aggressive surgical treatment is indicated by clinical studies for cases of inferior cava thrombus (IVCT), 5 the strong motivation of our patient to undergo surgery, despite all the risks involved, was a crucial element in the therapeutic decision. However, in this work, we have shown that this type of surgery, if performed with the adequate precautions, represents a safe and a technically feasible procedure in carefully selected patients.…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic radical nephrectomy with inferior vena cava thrombectomy: A combined retroperitoneal and transperitoneal approach

et al. 2018

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Renal cell carcinoma with inferior cava thrombus indicates biologically aggressive cancer, so the complete surgical resection remains standard of care with best long-term outcomes. Laparoscopic radical nephrectomy with vena cava thrombectomy represents nowadays a mini-invasive surgical alternative to the classic open nephrectomy. We present the case of a patient with incidental diagnosis of a right renal mass with level II inferior cava thrombus completely managed with both retroperitoneal and transperitoneal approaches. The use of a double access was planned to ensure a safe and complete vascular control. In our opinion, optimal patient selection, extensive laparoscopic experience, and knowledge of both transperitoneal and retroperitoneal approaches are critical elements for the safe application of this technique, although this procedure remains challenging and technically demanding.

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“…Currently most authors agree that the presence of the thrombus itself has no specific prognostic significance if it can be removed successfully (16). With advances in immunotherapy and molecular targeted therapy with such agents as interferon and Sorafenib, control of distant metastases in patients with RCC extending into the IVC can be achieved, thus survival of these patients may increase if aggressive surgery including tumor thrombectomy is combined with immunotherapy and molecular targeted therapy.…”

Section: Discussionmentioning

confidence: 99%

Pure Conventional Laparoscopic Radical Nephrectomy with Level II Vena Cava Tumor Thrombectomy

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________The surgical management with laparoscopic technique for renal cell carcinoma with inferior vena cava tumor thrombus (IVTT) remains challenging and technically demanding in urological oncology. We present two patients with level II IVTT that were managed with pure conventional laparoscopic radical nephrectomy and thrombectomy. Two patients were diagnosed with a renal tumor with level II IVTT from December 2011 to January 2012. They both underwent pure conventional laparoscopic radical nephrectomy with thrombectomy. During these operations, intraoperative laparoscopic ultrasonography was used to detect the thrombus and ensure complete removal. Two patients were operated through retroperitoneal approach for right renal tumor and transperitoneal approach for left renal tumor respectively. The demographics, perioperative and follow-up data were recorded for the study. Both operations were successfully performed without conversion. They both had no radiographic evidence of recurrence during follow-up. It is concluded that it is feasible to manage renal cell carcinoma with level II IVTT through pure conventional laparoscopic approach in carefully selected patients, which might expand the indication for laparoscopic surgery. The pure laparoscopic approach in the treatment of renal cell carcinoma with level II vena cava tumor thrombus is challenging and requires advanced laparoscopic skills. Multicenter prospective randomized control trials are needed to prove the benefits of this approach.

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Tumour nephrectomy with vena cava thrombus

Cited by 23 publications

References 17 publications

Treatment of renal cell carcinoma with a level III or level IV inferior vena cava thrombus using cardiopulmonary bypass and deep hypothermic circulatory arrest

Treatment of renal cell carcinoma with a level III or level IV inferior vena cava thrombus using cardiopulmonary bypass and deep hypothermic circulatory arrest

Laparoscopic radical nephrectomy with inferior vena cava thrombectomy: A combined retroperitoneal and transperitoneal approach

Pure Conventional Laparoscopic Radical Nephrectomy with Level II Vena Cava Tumor Thrombectomy

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