Περίληψη:
Introduction: Renal vein or inferior vena cava (IVC) invasion by
neoplastic thrombus in patients with renal cell carcinoma (RCC) is not
an obstacle for radical oncological treatment. The aim of this study is
to present our technical maneuvers for complete removal of the
intracaval thrombus without compromising hemodymanic stability of the
patient.
Materials and methods: Between 2000 and 2014, 15 RCC patients with IVC
involvement of levels IIII were treated with curative intent and were
prospectively studied. The operative technique varied according to
thrombus extent. For type I, extraction of the thrombus is facilitated
by a 23 cm longitudinal incision on the IVC that begins at the level of
the renal vein and extends cranially, encompassing a vessel wall rim of
the orifice of the resected renal vein. For type II cases, the IVC is
clamped above the neoplastic thrombus, and for type III, the IVC
clamping is combined with hepatic blood flow control with Pringle
maneuver. For type IV, the IVC is clamped above the diaphragm, or if the
thrombus extends into the right atrium cardiothoracic input is
appropriate.
Results: The main operative steps include preparation and control of the
renal vessels and the IVC. Occasionally, for type III tumor thrombi, the
patient becomes hemodynamically unstable when IVC is clamped
suprahepatically. In such a case, a novel operative maneuver of milking
the thrombus below the orifice of the hepatic veins, and subsequently
the IVC clamp also beneath the hepatic veins, allowing release of the
Pringle maneuver is performed. This operative step restores hepatic
blood flow and hemodynamic stability and is based on the floating nature
of the thrombus into the IVC. Mean operative time was 120 min (range
from 90 to 180 min), and average liver and renal warm ischemia time was
20 min (range from 15 to 35 min). Postoperative overall hospital stay
ranged from 7 to 13 days.
Conclusion: The technical solutions employed in the current study allow
successful removal of neoplastic thrombi from the IVC in most cases,
associated with minimal perioperative complication rate even for
patients who due to multiple comorbidities would be considered otherwise
inoperable.
Συγγραφείς:
Dellaportas, Dionysios
Arkadopoulos, Nikolaos
Tzanoglou, Ioannis
and Bairamidis, Evgenios
Gemenetzis, George
Xanthakos, Pantelis
and Nastos, Constantinos
Kostopanagiotou, Georgia
Vassiliou,
Ioannis
Smyrniotis, Vassilios
