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Goyal VD, Gupta S, Pahade A, Misra G, Prajapati N. Ewing's sarcoma of kidney extending into IVC and RA: resection using modified cannulation strategy for CPB. Indian J Thorac Cardiovasc Surg 2024; 40:365-368. [PMID: 38681708 PMCID: PMC11045677 DOI: 10.1007/s12055-023-01662-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 05/01/2024] Open
Abstract
Ewing's sarcoma of the kidney is a rare tumor. Although renal carcinomas are known to involve the inferior cava, extension of the tumor up to the right atrium is not common. In the majority of cases when the tumor extends into the infrahepatic part of the inferior vena cava, it can be removed from the abdominal approach. Few patients require the use of cardiopulmonary bypass for removal of the tumor in the inferior vena cava and right atrium. The management of patients requiring resection of kidney tumors and right atrial mass is more complicated and requires a team approach consisting of oncosurgeons, cardiac surgeons, and cardiac anesthetists. The resection of the kidney tumor with a mass in the right atrium is usually done concomitantly. The cardiopulmonary bypass cannulation strategy needs to be modified in such cases.
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Affiliation(s)
- Vikas Deep Goyal
- Department of Surgery, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, UP 243202 India
| | - Shubhanshu Gupta
- Department of Surgery, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, UP 243202 India
| | - Akhilesh Pahade
- Department of Anesthesia, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, UP 243202 India
| | - Gaurav Misra
- Department of Anesthesia, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, UP 243202 India
| | - Neeraj Prajapati
- Department of Radiodiagnosis, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, UP 243202 India
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Antala D, Ramachandran A, Trongtorsak A, Gidron A. Complete resolution of right atrium tumor thrombus with immunotherapy: A case report. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2022. [DOI: 10.1016/j.cpccr.2022.100180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chaud GJ, Lacombe L, Dagenais F. Double inferior vena cava systems during retroperitoneal surgery: Description of a systematic approach to a rare and challenging anatomic variant. J Vasc Surg Cases Innov Tech 2022; 8:81-84. [PMID: 35128221 PMCID: PMC8799992 DOI: 10.1016/j.jvscit.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/08/2021] [Indexed: 11/24/2022] Open
Abstract
Detailed knowledge of the various venous anomalies is important to optimize the surgical approach and minimize catastrophic complications during retroperitoneal surgery. We report a rare case of an isolated left inferior vein cava (IVC) in a patient with left renal cell carcinoma with level IV IVC thrombus extension, which was successfully treated with terminal–lateral anastomoses between the left and right IVC. We also reviewed the types of duplicated IVCs and discussed the intraoperative management.
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Liu Z, Li Y, Zhang Y, Zhao X, Ge L, Tang S, Hong P, Zhang S, Tian X, Wang S, Liu C, Zhang H, Ma L. PUTH Grading System for Urinary Tumor With Supradiaphragmatic Tumor Thrombus: Different Surgical Techniques for Different Tumor Characteristics. Front Oncol 2022; 11:735145. [PMID: 35070959 PMCID: PMC8770268 DOI: 10.3389/fonc.2021.735145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/09/2021] [Indexed: 01/11/2023] Open
Abstract
Purpose To explore the different treatment strategies for urinary tumors with Mayo IV thrombus. Materials and Methods We retrospectively analyzed the patients with Mayo IV thrombus in Peking University Third Hospital from January 2014 to April 2021. We used the Peking University Third Hospital (PUTH) grading system to classify urinary tumors with supradiaphragmatic thrombus. PUTH-A referred to the filled thrombus whose tip just reached above the diaphragm, or the thrombus entering the right atrium (< 2cm). PUTH-B referred to the filled thrombus entering the right atrium (> 2cm), or the thrombus invading the wall of the inferior pericardial vena cava. Detailed techniques were described for various scenarios. Clinicopathological data and perioperative outcomes were reported. Group difference statistical analysis was performed. Results A total of 26 cases of urinary tumors with supradiaphragmatic IVC thrombus (Mayo grade IV) underwent treatment were enrolled in this study. 19 patients in the PUTH-A group received the open approach without sternotomy and cardiopulmonary bypass. Seven patients in the PUTH-B group received open thoracotomy assisted by cardiopulmonary bypass. No intraoperative death occurred. After 56 months of follow-up, 46.2% (12 of 26) patients died of all causes. Estimated 1-year, 2-year, and 3-year overall survival were 72.0% (95% CI, 54.4%-89.6%), 58.2% (95% CI, 38.0%-78.4%), and 52.4% (95% CI, 31.2%-73.6%), respectively. Conclusions We introduced the PUTH grading system for the characteristics of urinary tumors with supradiaphragmatic tumor thrombus, and selected different surgical techniques according to different classifications. This grading system was relatively feasible and effective.
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Affiliation(s)
- Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Yuxuan Li
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Yu Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Xun Zhao
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Liyuan Ge
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shiying Tang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shumin Wang
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
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Surgical treatment of renal cell carcinoma with inferior vena cava tumor thrombus. Surg Today 2022; 52:1125-1133. [PMID: 34977987 DOI: 10.1007/s00595-021-02429-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The present report discusses the indications of cardiopulmonary bypass (CPB) in open nephrectomy and surgical outcomes of conventional and minimally invasive surgical techniques for treating advanced renal cell carcinoma with inferior vena cava tumor thrombus. METHODS The present study involved a comprehensive retrieval of pertinent literature from the most recent two decades. RESULTS Comparisons between radical nephrectomy procedures in terms of open, laparoscopic and robotic-assisted surgeries revealed that open surgery had more blood loss, a longer operation time and higher mortality rates than laparoscopic and robotic-assisted surgeries. Furthermore, surgery with CPB was associated with more blood loss than non-CPB surgery. Rates of early and late deaths were much higher in patients with CPB than in those without CPB. CONCLUSIONS Different surgical techniques had different indications in terms of levels of inferior vena cava tumor thrombus. The laparoscopic, robotic-assisted, open surgical techniques and CPB with deep hypothermic circulatory arrest were indicated for Levels I, II, III and III-IV inferior vena cava tumor thrombus, respectively. Laparoscopic and robotic-assisted surgeries cause less trauma than open surgery but require more complicated equipments to support the procedure. CPB should be avoided in radical nephrectomy whenever possible. The increased application of laparoscopic and robotic techniques in the future is anticipated.
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Liu Z, Li Y, Zhao X, Ge L, Zhu G, Hong P, Tang S, Zhang S, Tian X, Wang S, Liu C, Zhang H, Ma L. Renal cell carcinoma with tumor thrombus growing against the direction of venous return: an indicator of complicated surgery and poor prognosis. BMC Surg 2021; 21:443. [PMID: 34963464 PMCID: PMC8713414 DOI: 10.1186/s12893-021-01448-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To explore the effect of tumor thrombus growing against the direction of venous return (GADVR) tumor thrombus on the choice of surgical approach, the impact on the complexity of the surgery and the prognosis. METHODS We retrospectively analyzed the clinicopathological data of 213 patients, who underwent surgery in a single center of Peking University Third Hospital between January 2016 and June 2020. For right renal cell carcinoma (RCC) and venous tumor thrombus (VTT), imaging revealed a filling defect in the left renal vein, which was significantly enhanced in enhanced imaging, suggesting that the tumor thrombus grew against the direction of venous return into the left renal vein. For left RCC and VTT, at least one of the left renal vein branches has tumor thrombus. The branches include the left adrenal vein, the left gonadal vein (testicular vein or ovarian vein), and the left ascending lumbar vein. The patients were divided into two groups according to whether they were GADVR tumor thrombus, and we compare the clinicopathological characteristics of GADVR tumor thrombus and non-GADVR tumor thrombus. Univariate and multivariate Cox regression analyses were performed to explore the risk factors that affect the prognosis of patients with RCC and VTT. Kaplan-Meier plots were conducted to evaluate the effect of GADVR on progression-free survival (PFS). RESULTS Compared with non-GADVR tumor thrombus, patients with GADVR tumor thrombus had a higher proportion of open surgery (76.2% vs. 52.1%, P = 0.035), a higher proportion of tumor thrombus adhering to the inferior vena cava (IVC) vessel wall (81% vs. 45.8%, P = 0.002), a higher proportion of segmental resection of the IVC vessel wall (61.9% vs. 15.6%, P < 0.001); higher preoperative serum creatinine value (110.0 μmol/L vs. 91.0 μmol/L, P = 0.015), a higher proportion of tumor thrombus combined with bland thrombus (non-tumor thrombus) (57.1% vs. 19.8%, P < 0.001). In terms of surgical complexity, patients with GADVR tumor thrombus had a longer median operation time (379 min vs. 308 min, P = 0.038), more median surgical blood loss (1400 mL vs. 600 mL, P = 0.018), and more postoperative complications (52.4% vs. 30.7%, P = 0.045). Multivariate Cox regression analysis showed that GADVR tumor thrombus, symptoms, postoperative serum creatinine, distant metastasis, sarcomatoid feature, pathological type, lymph node dissection were independent risk factors for PFS. Patients with GADVR tumor thrombus's median survival time was 14.0 months, while patients with non-GADVR tumor thrombus were 32.0 months (P = 0.016). GADVR tumor thrombus is an independent risk factor for PFS in patients with RCC and VTT. CONCLUSION GADVR tumor thrombus is a characteristic feature of tumor thrombus, with an incidence of 9.9%. It has a higher proportion of open surgery and higher surgical complexity, which is an independent risk factor for PFS.
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Affiliation(s)
- Zhuo Liu
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Yuxuan Li
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Xun Zhao
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Liyuan Ge
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Guodong Zhu
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Shiying Tang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Shumin Wang
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China.
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Surgical Resection of Tumors Invading the Inferior Vena Cava at the Hepatic Vein and Thoracic Levels. World J Surg 2021; 45:3174-3182. [PMID: 34218311 DOI: 10.1007/s00268-021-06227-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Our aim was to describe the results of our program of surgical resection of tumors invading the inferior vena cava (IVC) at the hepatic and thoracic levels. We hypothesized that similar surgical outcomes may be obtained compared to tumor resection below the hepatic vein level if the liver function was preserved. METHODS We performed a single-center retrospective study of 72 consecutive patients who underwent surgical resection from 1996 to 2019 for tumors invading the IVC. We compared two groups based on tumor location below (group I/II) or above (group III/IV) the inferior limit of hepatic veins. RESULTS Tumor histology was similarly distributed between groups. In group III/IV (n = 35), sterno-laparotomy was used in 83% of patients, cardiopulmonary bypass in 77%, and deep hypothermic circulatory arrest in 17%; 23% underwent liver resection. Corresponding proportions in group I/II were 3%, 0%, 0%, and 8%. In group III/IV, 4 patients required emergency resection. Mortality on day 30 was 17% (n = 6) in group III/IV and 0% in group I/II (P = 0.01). There was no liver failure among the 66 postoperative survivors and 5 out of 6 patients who died postoperatively presented a preoperative or postoperative liver failure (P < 0.001). Overall survival was not significantly different between groups with a median follow-up of 15.1 months. R0 resection was achieved in 66% of group I/II and 49% of group III/IV patients (P = 0.03). CONCLUSION Surgical resection of tumors invading the inferior vena cava at hepatic vein and thoracic levels should be reserved to carefully selected patients without preoperative liver failure to minimize postoperative mortality.
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Gritsch D, Abdallah A, Taylor AM, Mesbah Z, Demaerschalk BM. Acute Ischemic Stroke as a Result of Paradoxical Embolus in a Patient with Renal Cell Carcinoma, Intravenous Tumor Thrombus Extension, and Patent Foramen Ovale. Neurologist 2021; 25:137-140. [PMID: 32925485 DOI: 10.1097/nrl.0000000000000276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Patent foramen ovale is a common congenital cardiac abnormality. An association with acute ischemic stroke is well described. Extension of renal cell carcinoma (RCC) into the adjacent veins is common. Surgical resection is felt to be an effective approach to treatment, even in the setting of extensive venous involvement. CASE REPORT A 55-year-old woman with recently diagnosed right renal mass and cavoatrial tumor thrombus was transferred to our facility for surgical resection. She subsequently underwent open radical right nephrectomy, regional lymph node dissection, inferior vena cava and right atrial tumor thrombectomy, and resection of the infrahepatic vena cava. An intraoperative transesophageal echocardiogram confirmed the absence of tumor thrombus from the inferior vena cava and right atrium and also identified a patent foramen ovale (PFO). Upon weaning sedation, she was noted to be agitated and have left hemiplegia. Her National Institutes of Health Stroke Scale (NIHSS) was 30 and Glasgow Coma Scale (GCS) 6. The computerized tomography scan of head revealed extensive hypoattenuation right in the middle and left posterior cerebral artery territories. There was associated cerebral edema and 5-mm midline shift. In the setting of devastating neurological injury, her family elected to transition to comfort care and the patient died on the postoperative day 7. CONCLUSIONS This is the first reported case of intraoperative paradoxical embolism in the setting of RCC with cavoatrial extension and PFO. The presence of PFO may be a risk factor for severe cerebrovascular complications in the surgical management of RCC with venous involvement.
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Klein-Weigel PF, Elitok S, Ruttloff A, Reinhold S, Nielitz J, Steindl J, Lutfi P, Rehmenklau-Bremer L, Hillner B, Fuchs H, Wrase C, Herold T, Beyer L. Inferior vena cava-syndrome. VASA 2021; 50:250-264. [PMID: 33459041 DOI: 10.1024/0301-1526/a000919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Inferior vena cava syndrome (IVCS) is caused by agenesis, compression, invasion, or thrombosis of the IVC, or may be associated with Budd-Chiari syndrome. Its incidence and prevalence are unknown. Benign IVCS is separated from malignant IVCS. Both cover a wide clinical spectrum reaching from asymptomatic to highly symptomatic cases correlated to the underlying cause, the acuity, the extent of the venous obstruction, and the recruitment and development of venous collateral circuits. Imaging is necessary to determine the underlying cause of IVCS and to guide clinical decisions. Interventional therapy has changed the therapeutic approach in symptomatic patients. This article provides an overview over IVCS and focuses on interventional therapeutic methods and results.
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Affiliation(s)
- Peter Franz Klein-Weigel
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Saban Elitok
- Nephrology, Endokrinology/Diabetology, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Andreas Ruttloff
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Sabine Reinhold
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Jessica Nielitz
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Julia Steindl
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Philippe Lutfi
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | | | - Birgit Hillner
- Institute of Radiodiagnostic, Helios Klinikum Buch, Berlin, Germany
| | - Heiko Fuchs
- Diagnostic and Interventionel Radiology, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Christian Wrase
- Diagnostic and Interventionel Radiology, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Thomas Herold
- Institute of Radiodiagnostic, Helios Klinikum Buch, Berlin, Germany
| | - Lukas Beyer
- Diagnostic and Interventionel Radiology, Ernst von Bergmann Klinikum Potsdam, Germany
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Nason GJ, Ajib K, Tan GH, Woon DTS, Christakis GT, Nam RK. Radical nephrectomy with resection of vena cava thrombus using extracorporeal circulation and deep hypothermic circulatory arrest. Can Urol Assoc J 2020; 15:E199-E204. [PMID: 33007182 DOI: 10.5489/cuaj.6736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Patients with renal cell carcinoma (RCC) with level 3 or 4 caval thrombus have a poor prognosis, with reported five-year survival rates of 30-40%. The aim of this study was to assess the perioperative morbidity and long-term oncological outcomes for radical nephrectomy with resection of vena cava thrombus using a combined surgical approach, including extracorporeal circulation and deep hypothermic circulatory arrest. METHODS A retrospective review was performed of the institutional case log to identify all radical nephrectomies with caval thrombus performed from January 2006 to May 2020. RESULTS Twenty-five patients were identified with level 2 thrombus in one (4%), level 3 thrombus in eight (32%), and level 4 in 16 (64%). The median followup was 20.6 months (range 0.2-133.3). The median age at surgery was 68.4 years (range 44.2-85.5). Twenty-one (84%) patients were symptomatic at presentation. Six (24%) patients had distant metastases at diagnosis. The median circulatory arrest time was 15 minutes (range 6-35). The 30-day grade ≥3 complication rate was 8%. The 30-day mortality rate was 8%. The one-year, two-year, three-year, and five-year recurrence-free survival (RFS) rates were 53%, 18%, 10%, and 10%, respectively. The median time to systemic treatment was 7.7 months (range 1.2-25.7). The one-year, two-year, three-year, and five-year overall survival (OS) rates were 70%, 43%, 36%, and 31%, respectively. CONCLUSIONS Radical nephrectomy with resection of vena cava thrombus using extracorporeal circulation and deep hypothermic circulatory arrest is associated with some morbidity and mortality but remains a safe and effective strategy for advanced RCC patients who would otherwise be managed palliatively.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Khaled Ajib
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Guan Hee Tan
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Dixon T S Woon
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - George T Christakis
- Division of Cardiac Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Robert K Nam
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
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One-step reconstruction of IVC and right hepatic vein using reversed auto IVC and left renal vein graft. Int J Surg Case Rep 2019; 57:57-59. [PMID: 30903855 PMCID: PMC6430719 DOI: 10.1016/j.ijscr.2019.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/23/2019] [Accepted: 03/05/2019] [Indexed: 01/04/2023] Open
Abstract
The left liver lobe was resected including the tumor and IVC ex vivo, and the right hepatic vein were reconstructed using the reversed patient’s left renal vein (LRV) and IVC graft. The patient’s right liver lobe with the reversed LRV/IVC graft was transplanted back into the patient using a partial liver transplant technique.
Introduction A malignant tumor invading the inferior vena cava (IVC) and concomitant with 3 hepatic venous involvement still remains surgical therapeutic challenge. Presentation of case A 79-year-old male presented with liver dysfunction and was eventually diagnosed with an intrahepatic huge IHCC originating at the level of confluence of 3 hepatic veins to the IVC, extending to the right hepatic vein (HV). Under extracorporeal circulation, the liver with the IVC, portal vein, hepatic artery and common bile duct were removed en bloc. In the back table, the left liver lobe was resected including the tumor and IVC, and the right HV was reconstructed using the patient’s reversed left renal vein (LRV) and IVC graft. Subsequently, the patient’s right liver lobe with the reversed LRV/IVC graft was transplanted back into the patient using a partial liver transplant technique. Liver enzymes gradually came down to the value within normal range on postoperative day 13 with the patency of the right HV. However, the patient expired on POD 16 because of sudden septic complications. Discussion This technique could be one of the options to reconstruct the HV/IVC when a tumor invades all 3 HVs. Conclusion To the best of our knowledge, this is the first report of such HV reconstruction in combination with extracorporeal resection of huge liver cancer in updated world literature.
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Wang BS, Ma RZ, Liu YQ, Liu Z, Tao LY, Lu M, Wang GL, Zhang SD, Lu J, Ma LL. Body mass index as an independent risk factor for inferior vena cava resection during thrombectomy for venous tumor thrombus of renal cell carcinoma. World J Surg Oncol 2019; 17:17. [PMID: 30646899 PMCID: PMC6334420 DOI: 10.1186/s12957-019-1560-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022] Open
Abstract
Objective To define preoperative clinical and radiographic risk factors for the need of inferior vena cava (IVC) resection in patients with renal cell carcinoma (RCC) and IVC tumor thrombus. Methods We reviewed data of 121 patients with renal cell carcinoma and venous tumor thrombus receiving radical nephrectomy and thrombectomy at our institution between 2015 and 2017, and 86 patients with Mayo I–IV level tumor thrombus were included in the final analysis. Clinical features, operation details, and pathology data were collected. Preoperative images were reviewed separately by two radiologists. Univariable and multivariable logistic regression analyses were applied to evaluate clinical and radiographic risk factors of IVC resection. Results Of the 86 patients, 44 (51.2%) received IVC resection during thrombectomy. In univariate analysis, we found that body mass index (BMI) (odds ratio [OR] = 1.22, P = 0.003), primary tumor diameter (OR = 0.84, P = 0.022), tumor thrombus width (OR = 1.08, P = 0.037), tumor thrombus level (OR = 1.57, P = 0.030), and IVC occlusion (OR = 2.67, P = 0.038) were associated with the need for resection of the IVC. After adjusting for the other factors, BMI (OR = 1.18, P = 0.019) was the only significant risk factor for IVC resection. Multivariable analysis in Mayo II–IV subgroups confirmed BMI as an independent risk factor (OR = 1.26, P = 0.024). A correlation between BMI and the width (Pearson’s correlation coefficient [PCC] = 0.27, P = 0.014) and length (PCC = 0.23, P = 0.037) of the tumor thrombus was noticed. Conclusion We identified BMI as an independent risk factor for IVC resection during thrombectomy of RCC with tumor thrombus in a Chinese population. More careful preoperative preparation for the IVC resection and/or reconstruction is warranted in patients with higher BMI.
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Affiliation(s)
- Bin-Shuai Wang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Run-Zhuo Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Yu-Qing Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Li-Yuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Min Lu
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Guo-Liang Wang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shu-Dong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Jian Lu
- Department of Urology, Peking University Third Hospital, Beijing, China.
| | - Lu-Lin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China.
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Mavrigiannaki E, Fesatidis I, Kalogridaki E, Katralis IP, Filippou D, Skandalakis P, Vrochides D. Synchronous nephrectomy and cavoatrial tumor thrombectomy under normothermic extracorporeal circulation and beating heart. J Surg Case Rep 2018; 2018:rjy095. [PMID: 29780574 PMCID: PMC5952965 DOI: 10.1093/jscr/rjy095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/02/2018] [Accepted: 04/26/2018] [Indexed: 11/14/2022] Open
Abstract
Formation of tumor thrombus is an occasional manifestation of renal cell carcinoma (RCC). Intravascular invasion of the renal vein and thereafter the inferior vena cava (IVC) might in very rare cases extend into the cardiac chambers. The subtle course and symptoms of such cases alongside with the engagement of vital anatomical structures marks them as a diagnostic and therapeutic challenge. Aggressive surgical intervention has proven to be critical for survival rates in such cases; however total synchronous resection remains a challenge for the surgical team and a debate for the medical community. Following we report the case of a 66-year-old male who was diagnosed with a RCC of the right kidney accompanied by a tumor thrombus extending into the right atrium, after he suffered a presyncope episode. The patient underwent a radical en bloc nephrectomy and tumor thrombectomy under extracorporeal circulation with beating heart.
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Affiliation(s)
- Eleftheria Mavrigiannaki
- Department of Pediatric Surgery General Children's Hospital 'Agia Sofia', Athens, Greece.,Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodestrian University of Athens, Greece
| | - Ioannis Fesatidis
- Department of Cardiac Surgery Euromedica Clinic, Thessaloniki, Greece
| | - Evgenia Kalogridaki
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodestrian University of Athens, Greece
| | - Ioannis-Petros Katralis
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodestrian University of Athens, Greece
| | - Dimitrios Filippou
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodestrian University of Athens, Greece
| | - Panagiotis Skandalakis
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodestrian University of Athens, Greece
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Catalá-Ripoll JV, Mateo-Rodríguez E, Juez-López M, Martín-González I, Doménech-Pérez C, Martínez-León J, Carmona-García P, Genovés-Crespo M. Cirugía de tumores retroperitoneales con afectación de vena cava: revisión de 18 casos. CIRUGIA CARDIOVASCULAR 2018. [DOI: 10.1016/j.circv.2017.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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