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[Segmental vena cava resection for the treatment of renal tumor with invading tumor thrombus]
1Department of Urology, Peking University Third Hospital, Beijing100191, China.
Objective:
To investigate the safety and perioperative experience of the segmental resection of the vena cava.
Methods:
From May 2015 to July 2017, 92 renal tumor patients with venous tumor thrombus were treated in Peking University Third Hospital, of whom 17 underwent nephrectomy with resection of the invaded vena cava for renal tumor with tumor thrombus invading vena cava. The preoperative features included that 15 patients were male and 2 female, the mean age was (59.2±12.9) years (31-84 years), 6 cases were left sided and 11 right sided, and the mean diameter of the renal tumor was (9.1±3.7) cm (3-14.5 cm).
Results:
In this group of 17 cases, 5 patients underwent resection of the vena cava via laparoscopy (including 2 open conversions), and 12 via open procedures (including 2 cardiopulmonary bypasses). The mean operation time was (430.4±120.7) min (284-694 min) and the mean intraoperative blood loss was (2 918.8±2 608.2) mL (300-10 000 mL). The vena cava from the bottom to the top was transected. The median length of the tumor thrombus in the vena cava was 10 cm (3-21 cm). Postoperative complications were found in 11 patients, including grade I in 1 case, grade II in 7 cases, grade IV in 2 cases and grade V in 1 case according to the Clavien system. The median postoperative creatinine was 116 μmol/L (79-645 μmol/L) with 2 patients needing dialysis. The postoperative pathology revealed that renal clear cell carcinoma in 10 cases, papillary carcinoma in 5 cases, urothelial carcinoma in 1 case and fusiform cell sarcoma in 1 case. During the median follow-up of 8 (1-28) months, 1 patient died during perioperative period, 1 patient died from multiple metastasis in 9 months postoperatively, 3 patients found distant metastasis and 2 cases remained lower extremity edema after operation.
Conclusion:
The segmental resection of the vena cava may be a good choice for non-metastatic renal tumors with tumor thrombus invading vena cava. The short term follow-up results revealed a satisfactory safety and feasibility.
Insights
Segmental resection of the vena cava is a safe and feasible option for non-metastatic renal tumors with venous tumor thrombus. This surgical approach demonstrated satisfactory short-term outcomes in patients undergoing this complex procedure.
Area of Science:
- Urology
- Surgical Oncology
- Vascular Surgery
Background:
- Renal tumors with tumor thrombus invading the vena cava present complex surgical challenges.
- Nephrectomy with vena cava resection is a critical procedure for managing these cases.
Purpose of the Study:
- To evaluate the safety and perioperative outcomes of segmental resection of the vena cava in patients with renal tumors and venous tumor thrombus.
Main Methods:
- A retrospective analysis of 17 patients who underwent nephrectomy with vena cava resection for renal tumors with tumor thrombus invasion.
- Procedures were performed via laparoscopy or open surgery, with some requiring cardiopulmonary bypass.
Main Results:
- The mean operative time was approximately 430 minutes with significant blood loss. Postoperative complications occurred in 11 patients (Clavien system grades I-V).
- Pathology revealed various renal cell carcinoma subtypes and sarcoma. Short-term follow-up showed one perioperative death and other complications like metastasis and lower extremity edema.
Conclusions:
- Segmental resection of the vena cava is a viable and safe surgical option for select non-metastatic renal tumors with vena cava invasion.
- The study indicates satisfactory short-term safety and feasibility for this oncological surgery.
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