Neoplastic Thrombosis of the Inferior Vena Cava in Kidney Carcinoma
Authors:
V. Třeška 1; M. Hora 2; J. Ferda 3; O. Hes 4; A. Ňaršanská 1; Z. Matkovčík 1
Authors‘ workplace:
Chirurgická klinika FN a LF UK v Plzni, přednosta: prof. MUDr. Vladislav Třeška, DrSc.
1; Urologická klinika FN a LF UK v Plzni, přednosta: doc. MUDr. Milan Hora, Ph. D.
2; Radiodiagnostická klinika FN a LF UK v Plzni, přednosta: doc. MUDr. Boris Kreuzberg, CSc.
3; Šiklův patologicko-anatomický ústav FN a LF UK v Plzni, přednosta: prof. MUDr. Michal Michal, Ph. D.
4
Published in:
Rozhl. Chir., 2009, roč. 88, č. 4, s. 196-199.
Category:
Monothematic special - Original
Overview
Introduction:
Neoplastic thromboses of the inferior vena cava occur in about 4–15% of patients with conventional, clear-cell renal carcinoma, and significantly increase intraoperative mortality and morbidity rates.
Aim:
Assessment of outcomes of radical nephrectomies with inferior vena cava thrombectomies, performed in the Plzeň Faculty Hospital from 01-01-1999 to 31-12-2008.
Patient groups and Methods:
The study included 16 patients, 12 males and 4 females of 63.6 years of age on average (44–75 y.o.a), suffering from conventional, clear-cell renal carcinoma and neoplastic thrombosis of the inferior vena cava. The main symptoms included hematuris in 7 subjects (43.8%), lumbar pressure pain in 4 subjects (25%), leg edema in 2 subjects (12.5%). In 2 patients (12.5%), the finding was accidental and in 1 patient (6.3%), the symptoms were caused by distant metastases. The diagnostic methods included duplex sonography, multidetector computed tomography, magnetic resonance imaging and cavography. In three subjects, the thrombus was located in the renal vein only (grade I), in 9 subjects, the thrombus propagated below the entry of the hepatic veins (grade II), in 3 subjects, the thrombus extended above the entry of the hepatic veins (grade III) and, in 1 patient, it reached the right atrium (grade IV). All the patients underwent transabdominal radical nephrectomy (pT3b,c,pN0-2,pM 0-1) and inferior vena cava thrombectomy.
Results:
The average duration of IVC closure using vascular clips was 6.3 minutes (3–12 minutes), the average blood loss was 1.7 litres. The intraoperativev mortality rate of the whole study group was 0%. In a single patient, an incompletely removed thrombus resulted in massive pulmonary embolization on day 3, which was urgently managed by cardiosurgery with extracorporeal circulation, when the thrombotic mass was removed from the pulmonary artery.
Three subjects (18.
8%) died due to generalization of the underlying disease 5–17 months after the primary procedure. Two subjects (12.5%) are currently receiving symptomatic treatment for their generalized underlying disease. 11 subjects (68.8%) show no signs of a relaps of the underlying disease at 3 month–5 years after the procedure.
Conclusion:
Radical nephrectomy combined with complete removal of the neoplastic thrombus provides the best prospects for long-term survival rates of the patients.
Key words:
conventional clear-cell renal carcinoma – neoplastic thrombus – thrombectomy
Sources
1. Morávek, P., Navrátil, P. jr., Habal, P., Procházka, E. Chirurgická léčba karcinomu ledviny s nádorovým trombem v žilním řečišti hladiny III. Urológia, 2006; 4, s. 18–23.
2. Kaplan, S., Ekici, S., Dogan, R., Demiricin, M., Ozen, H., Pasaoglu, I. Surgical management of renal cell carcinoma with inferior vena cava tumor thrombus. AJS, 2002; 183, s. 292–299.
3. Wang, J. C., Carpenter, J. P., Fairman, R. M., Jackson, B. M., Malkowicz, B., van Arsdalen, K. N., Woo, E. Y. Single-center experience of caval thrombectomy in patients with renal cell carcinoma with tumor thrombus extension into the inferior vena cava. Vasc. Surg., 2008; 42, s. 335–340.
4. Slaton, J. W., Balbay, M. D., Levy, D. A., Pisters, L. L., Nesbitt, J. C., Swanson, D. A., Dinney, C. P. N. Nephrectomy and vena caval thrombectomy in patients with metastatic renal cell carcinoma. Urology, 1997; 50, s. 637–677.
5. Ferda, J., Hora, M., Hes, O., Ferdová, E., Kreuzberg, B. Assesment of the kidney tumor vascular supply by two-phase MDCT-angiography. Eur. J. Radiol., 2007; 62, s. 295–301.
6. Ferda, J., Kreuzberg, B., Hes, O., Hora, M., Ferdová, E., Baxa, J., Mírka, H., Ohlídalová, K. Dvoufázová multidetektorová CT-angiografie renálního karcinomu. Čes. Radiol., 2007; 61, s. 1–19.
7. Zini, L.,Koussa, M., Haulon, S., Decoene, Ch., Fantoni, J., Ch., Biserte, J., Villers, A. Results of endoluminal occlusion of the inferior vena cava during radical nephrectomy and thrombectomy. Eur. Urol., 2008; 54, s. 78–784.
8. Jibiki, M., Iwai, T., Inoue, Y., Sugano, N., Kihara, K., Hyochi, N., Sunamori, M. Surgical strategy for treating renal cell carcinoma with thrombus extending into the inferior vena cava. J. Vasc. Surg., 2004; 39, s. 829–835.
9. Skinner, D. G., Pritchett, T. R., Lieskovsky, G. Vena caval involvement by renal cell carcinoma. Surgical resection provides meaningful long-term survival. Ann. Surg., 1989; 210, s. 387–394.
10. Kirkali, Z., van Poppel, H. A critical analysis of surgery for kidney cancer for vena cava invasion. Eur. Urol., 2007; 52, s. 658–662.
11. Wellons, E., Rosenthal, D., Schoborg, T., Shuler, F., Levitt, A. Renal cell carcinoma invading the inferior vena cava: use of a temporary vena cava filter to prevent tumor emboli during nephrectomy. Urology, 2004; 63, s. 380–386.
12. Hora, M., Klečka, J., Ferda, J., Hes, O., Urge, T. Laparoskopická radikální nefrektomie u tumoru s žilním nádorovým trombem (T3b). Čes. Urol., 2005; 9, s. 52–55.
13. Lori, E. S., Itay, Y. V., Bhayani, S. B. Laparoscopic radical nephrectomy for renal carcinoma with known level I renal vein tumor thrombus. Urology, 2007; 69, s. 662–665.
14. Reissigl, A., Janetschek, G., Eberle, J. Renal cell carcinoma extending into the vena cava: surgical approach,technique and results. J. Urol., 1995; 75, s. 138–142.
15. Libertino, J. A., Zinman, L., Watkins, E. Long term results of renal cell cancer with extension into inferior vena cava. J. Urol., 1987; 137, s. 21–24.
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Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2009 Issue 4
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