Single-center Experience With Surgical Management of Tumor Thrombus Intravascular Extension in Pediatric Renal...

To evaluate surgical strategies and outcomes for children with intravascular extension of pediatric renal tumors by reviewing intraoperative observations and individual surgical challenges.

A retrospective chart review was undertaken on patients undergoing radical nephrectomy at our institution between 2005 and 2023. Patients identified with intravascular (vena cava) extension were included. Demographics, Daum stage from imaging, peri-operative course, surgical details, complications, and survival was collected. Descriptive statistics were calculated.

A total of 11 patients were included (10 Wilms tumors, 1 Ewing's Sarcoma). The median age at presentation was 4 years (IQR 3, 5) and the median follow-up was 27 months (IQR 3, 37). In total, 8 patients (73%) underwent thrombectomy with cavotomy and 3 patients (27%) underwent thrombectomy with cavectomy for total occlusion, and 2 patients (18%) required cardiopulmonary bypass. Three patients (27%) had >500 mL intraoperative blood loss. Median length of surgery was 10 hours (IQR 8, 12). Three patients (27%) experienced complications, including hemoperitoneum requiring laparotomy, chylothorax managed conservatively, and post-operative fever requiring antibiotics, respectively. By the last follow-up, the overall survival rate was 100% and event-free survival was 89%.

In our study, tumor thrombus extension into the vena cava did not appear to have a negative effect on survival. The surgical approach should be tailored to pre- and intra-operative findings, including resection of a completely occluded cava with development of a collateral network.