Precise control of caval and hepatic vessels: Surgical technique to treat level III caval thrombus concomitant to renal cell carcinoma

Authors

  • Ming Chen Department of Urology, Affiliated Zhongda Hospital of Southeast University
  • Bin Xu Department of Urology, Affiliated Zhongda Hospital of Southeast University
  • Ning Liu Department of Urology, Affiliated Zhongda Hospital of Southeast University
  • Hua Jiang Department of Urology, Affiliated Zhongda Hospital of Southeast University
  • Yiduo Wang Department of Urology, Affiliated Zhongda Hospital of Southeast University
  • Yu Yang Department of Urology, Affiliated Zhongda Hospital of Southeast University
  • Xiaowen Zhang Department of Urology, Affiliated Zhongda Hospital of Southeast University
  • Chao Sun Department of Urology, Affiliated Zhongda Hospital of Southeast University
  • Jing Liu Department of Urology, Affiliated Zhongda Hospital of Southeast University
  • Weidong Zhu Department of Urology, Affiliated Zhongda Hospital of Southeast University
  • Shuqiu Chen Department of Urology, Affiliated Zhongda Hospital of Southeast University

DOI:

https://doi.org/10.5489/cuaj.3074

Keywords:

inferior vena cava, renal cell carcinoma, tumor thrombus, surgical technique

Abstract

Introduction: We investigated the surgical techniques, safety, and prevention of complications of nephrectomy and removal of tumour thrombus for treating level III inferior vena cava (IVC) concomitant to renal cell carcinoma (RCC). We did this by precise controlling IVC and hepatic vessels without a vascular bypass.

Methods: In this series, we included 5 patients with level III IVC tumour thrombus below the hepatic vein concomitant to RCC. After precisely controlling the IVC and hepatic vessels, we then removed the thrombus en bloc with the renal vein. Blood loss volume, IVC clamping time, hypotension time, resuscitation, cardiocerebrovascular complications, and postoperative organ dysfunction were observed.

Results: Surgery was successfully performed without perioperative death. Blood loss volume was 900 to 1500 mL, operation time was 165 to 250 minutes, vascular clamping time was 8 to 12 minutes, and intraoperative hypotension time was 9 to 12 minutes. Serious perioperative complications were not observed. Local recurrence was not observed during the 9 to 24 months of follow-up. One patient exhibited disease-free survival, 3 developed lung or liver metastasis, and 1 died 11 months after surgery.

Conclusion: Precise control of IVC and hepatic pedicle vessels, without vascular bypass, is a safe and effective surgical treatment for level III tumor thrombus below the hepatic vein concomitant to RCC. The procedure was conducted without increased risks of intraoperative hypotensive shock, difficult resuscitation, pulmonary embolism, and multiple organ dysfunctions.

Downloads

Download data is not yet available.

Downloads

Published

2015-11-04

How to Cite

Chen, M., Xu, B., Liu, N., Jiang, H., Wang, Y., Yang, Y., Zhang, X., Sun, C., Liu, J., Zhu, W., & Chen, S. (2015). Precise control of caval and hepatic vessels: Surgical technique to treat level III caval thrombus concomitant to renal cell carcinoma. Canadian Urological Association Journal, 9(11-12), E808–13. https://doi.org/10.5489/cuaj.3074