Surgical Techniques For Treating a Renal Neoplasm Invading The Inferior Vena Cava

Abstract

No AccessJournal of UrologyCLINICAL UROLOGY: Review Article1 Feb 2003Surgical Techniques For Treating a Renal Neoplasm Invading The Inferior Vena Cava ANIL VAIDYA, GAETANO CIANCIO, and MARK SOLOWAY ANIL VAIDYAANIL VAIDYA , GAETANO CIANCIOGAETANO CIANCIO , and MARK SOLOWAYMARK SOLOWAY View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)63931-6AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Historically inferior vena caval thrombus associated with renal cell carcinoma was a deterrent to surgery. During the last 3 decades there has been steady improvement in surgical techniques and perioperative care, which has dramatically improved the ability to resect safely these tumors. We acknowledge these improvements in chronological order. Materials and Methods: A comprehensive literature review of the different techniques used for resecting renal cell carcinoma with inferior vena caval involvement was performed using MEDLINE. Data focused on surgical techniques, including various incisions, exposures, adjuncts to surgery and outcomes. Results: Tumor thrombus associated with renal cell carcinoma is no longer considered to have a detrimental impact on survival. Patients who are acceptable surgical candidates have survival rates as high as 68%. Although there is a great deal of emphasis on the importance of an aggressive surgical approach, a uniform operative strategy based on the level of the tumor thrombus has not been established. Surgical techniques derived from liver transplant surgery and cardiac arrest with cardiopulmonary bypass have drastically decreased operative complications associated with extensive involvement of the inferior vena cava with tumor thrombus. Conclusions: The only curative approach to renal cell carcinoma is surgery. An aggressive approach is warranted when tumor involves the renal vein and inferior vena cava. Surgical strategy depends on the level of the inferior vena caval thrombus. Patients with extension of the thrombus above the diaphragm are a greater technical challenge. Hypothermic circulatory arrest should be considered when treating vena caval-atrial tumor thrombus. Surgeons familiar with liver mobilization can greatly facilitate the exposure needed for safely operating in these cases. References 1 : Surgical approach to inferior vena caval extension of renal cell carcinoma. Br J Urol1987; 60: 492. Google Scholar 2 : Prognosis of renal cell carcinoma with vena caval and renal vein involvement: an update. Am J Surg1987; 154: 49. Google Scholar 3 : Surgical management and prognosis of renal cell carcinoma invading the vena cava. J Urol1991; 145: 20. Link, Google Scholar 4 : Extension of renal cell carcinoma into the vena cava: clinical review and surgical approach. J Urol1986; 135: 460. Link, Google Scholar 5 : Cardiopulmonary bypass in patients with malignant renal neoplasms. Br J Anaesth1986; 58: 461. Google Scholar 6 : Renal cell cancer with extension into the vena cava. In: Rob & Smith's Operative Surgery: Urology. Edited by . London: Butterworths1986: 127. Google Scholar 7 : Surgical treatment of renal cancer with vena cava extension. Br J Urol1987; 59: 390. Google Scholar 8 : Renal-cell carcinoma with intracaval neoplastic extension: statification and surgical technique. World J Urol1995; 13: 166. Google Scholar 9 : Cardiovascular evaluation before circulatory arrest for removal of vena caval extension of renal carcinoma. J Urol1988; 141: 1302. Google Scholar 10 Blancardus. Cited by Schecter D.C. Cardiovascular surgery in the management of exogenous tumors involving the vena cava. In: Surgery of the Veins. Edited by . Orlando: Grune & Stratton1985: 393. chapt. 28. Google Scholar 11 : Malignant hypernephroma of the kidney. Its clinical course and diagnosis, with a description of the author's method of radical operative cure. Surg Gynecol Obstet1913; 17: 463. Google Scholar 12 : Gefasskomplikatnen und ihre Beherrschung bei dem hypernephrom. Z Urol Chir1922; 10: 326. Google Scholar 13 : Survey of the inferior vena cava. Clinical and experimental studies. Ann Surg1934; 99: 167. Google Scholar 14 : Radical nephrectomy for renal cell carcinoma. J Urol1963; 89: 37. Link, Google Scholar 15 : Surgery for renal cell carcinoma in the vena cava. J Urol1970; 103: 414. Link, Google Scholar 16 : Thrombosis and embolism resulting from renal tumors. JAMA1924; 82: 75. Google Scholar 17 : An improved technic for vascular isolation of the liver: experimental study and case reports. Ann Surg1966; 163: 237. Google Scholar 18 : Extension of renal cell carcinoma into the vena cava: the rationale for aggressive surgical management. J Urol1971; 107: 711. Google Scholar 19 : Resection of the vena cava for renal cell carcinoma: an experimental study. J Urol1972; 107: 717. Link, Google Scholar 20 : Aggressive surgery for renal cell carcinoma with vena cava tumor thrombus. Urology1975; 6: 227. Google Scholar 21 : The removal of renal carcinoma thrombus extending into the right atrium. J Urol1975; 113: 163. Link, Google Scholar 22 : Renal tumors involving the inferior vena cava: plan for management. J Urol1978; 120: 153. Link, Google Scholar 23 : Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg1908; 48: 541. Google Scholar 24 : Vena cava resection for renal cell carcinoma. J Urol1974; 112: 162. Link, Google Scholar 25 : Surgery for renal cell carcinoma extending into the inferior vena cava. J Urol1978; 120: 28. Link, Google Scholar 26 : Intraoperative management of renal cell carcinoma with supradiaphragmatic caval extension. J Urol1979; 122: 829. Link, Google Scholar 27 : Renal cell cancer invading the inferior vena cava: clinical review and anatomical approach. J Urol1979; 123: 157. Google Scholar 28 : Chirurgie der leber und gallenblase. Dtsche Chir1894; 45C: 1. Google Scholar 29 : Surgical approach for removal of renal cell carcinoma extending into the vena cava and the right atrium. J Urol1980; 123: 947. Link, Google Scholar 30 : Results of inferior vena cava resection for renal cell carcinoma. J Urol1981; 125: 769. Link, Google Scholar 31 Vaislic C., Puel P., Grondin P., Vargas A.: Surgical resection of neoplastic thrombosis in the inferior vena cava by neoplasms of renal-adrenal tract. Vasc Surg, September-October, p. 322, 1983 Google Scholar 32 : A new technique for management of renal cell carcinoma involving the right atrium: hypothermia and cardiac arrest. J Urol1984; 131: 103. Link, Google Scholar 33 : Cardiopulmonary bypass in patients with malignant renal neoplasms. Br J Anesth1986; 58: 461. Google Scholar 34 : Surgical management of renal cell carcinoma with vena cava tumor thrombus. Eur Urol1986; 12: 145. Google Scholar 35 : Long term results of resection of renal cell cancer with extension into the inferior vena cava. J Urol1987; 137: 21. Abstract, Google Scholar 36 : Surgical management of renal cell carcinoma with intracaval neoplastic extension above the hepatic veins. J Urol1988; 139: 1166. Link, Google Scholar 37 : Editorial comment. J Urol1988; 139: 1172. Google Scholar 38 : Editorial comment. J Urol1988; 139: 1172. Google Scholar 39 : Fiberoptic examination of the inferior vena cava during circulatory arrest for complete removal of renal cell carcinoma thrombus. Surgery1990; 107: 695. Google Scholar 40 : Transesophageal echocardiography in renal cell carcinoma: an accurate diagnostic technique for intracaval neoplastic extension. J Urol1991; 145: 1138. Link, Google Scholar 41 : Cavoatrial tumor thrombectomy using cardiopulmonary bypass without circulatory arrest. Ann Thorac Surg1991; 51: 717. Google Scholar 42 : Application of liver transplant and organ procurement techniques to difficult upper abdominal urological cases. J Urol1994; 151: 1652. Link, Google Scholar 43 : Radical nephrectomy in patients with renal cell carcinoma with venous, vena caval, and atrial extension. Am J Surg1994; 168: 205. Google Scholar 44 : Radical nephrectomy with vena caval thrombectomy using a minimal access approach for cardiopulmonary bypass. J Urol1998; 159: 1292. Link, Google Scholar 45 : Complete radical nephrectomy and vena caval thrombectomy during circulatory arrest. J Urol2000; 163: 434. Link, Google Scholar 46 : The use of liver transplant techniques to aid in the surgical management of urological tumors. J Urol2000; 164: 665. Link, Google Scholar 47 : Anesthetic management in radical surgery for urologic malignancies. In: Diagnosis and Management of Genitourinary Cancer. Edited by . Philadelphia: W. B. Saunders Co.1988: 595. Google Scholar From the Departments of Urology and Surgery (Division of Transplantation), University of Miami School of Medicine, Miami, Florida© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byHaferkamp A, Bastian P, Jakobi H, Pritsch M, Pfitzenmaier J, Albers P, Hallscheidt P, Müller S and Hohenfellner M (2018) Renal Cell Carcinoma With Tumor Thrombus Extension Into the Vena Cava: Prospective Long-Term FollowupJournal of Urology, VOL. 177, NO. 5, (1703-1708), Online publication date: 1-May-2007.Lowentritt B, Phelan M, VanZijl P, Philosophe B and Sklar G (2018) Venacavoscopy During Nephrectomy for Renal Cell Carcinoma With Inferior Vena Caval ThrombusJournal of Urology, VOL. 176, NO. 2, (468-471), Online publication date: 1-Aug-2006.Ciancio G and Soloway M (2018) RE: RENAL CELL CARCINOMA WITH RENAL VEIN AND INFERIOR VENA CAVAL INVOLVEMENT: CLINICOPATHOLOGICAL FEATURES, SURGICAL TECHNIQUES AND OUTCOMESJournal of Urology, VOL. 174, NO. 5, (2067-2067), Online publication date: 1-Nov-2005.SIEMER S, LEHMANN J, LOCH A, BECKER F, STEIN U, SCHNEIDER G, ZIEGLER M and STÖCKLE M (2018) CURRENT TNM CLASSIFICATION OF RENAL CELL CARCINOMA EVALUATED: REVISING STAGE T3aJournal of Urology, VOL. 173, NO. 1, (33-37), Online publication date: 1-Jan-2005.PAREKH D, COOKSON M, CHAPMAN W, HARRELL F, WELLS N, CHANG S and SMITH J (2018) RENAL CELL CARCINOMA WITH RENAL VEIN AND INFERIOR VENA CAVAL INVOLVEMENT: CLINICOPATHOLOGICAL FEATURES, SURGICAL TECHNIQUES AND OUTCOMESJournal of Urology, VOL. 173, NO. 6, (1897-1902), Online publication date: 1-Jun-2005. Volume 169Issue 2February 2003Page: 435-444 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordskidneyvena cava, inferiorvenous thrombosiskidney neoplasmsMetricsAuthor Information ANIL VAIDYA More articles by this author GAETANO CIANCIO More articles by this author MARK SOLOWAY Financial interest and/or other relationship with Astra Zeneca, Matritech, Merck and TAP. More articles by this author Expand All Advertisement PDF downloadLoading ...