Transabdominal Approach for Renal Cell Carcinoma with Supradiaphragmatic Tumor Thrombus: Description of a Modified Technique and Indications for Treatment

Overview

Journal J Int Med Res

Publisher Sage Publications

Specialty General Medicine

Date 2020 Nov 4

PMID 33143510

Authors

Guoliang Wang

Hai Bi

Jianfei Ye

Hongxian Zhang

Xiaofei Hou

Cheng Liu

Min Qiu

Yu Tian

Dharam Kaushik

Lulin Ma

Affiliations

Soon will be listed here.

Abstract

Objective: We investigated the safety and effectiveness of a modified transabdominal approach for renal cell carcinoma (RCC) with a supradiaphragmatic inferior vena cava (IVC) tumor thrombus (TT).

Methods: Eight patients underwent radical nephrectomy with removal of a supradiaphragmatic IVC-TT through an abdominal incision using a transdiaphragmatic approach in Peking University Third Hospital from April 2015 to January 2018. We modified this technique using a Foley catheter balloon to avoid piggyback liver mobilization.

Results: All patients underwent successful operations. The median operative time was 7 hours 23 minutes. The median estimated blood loss was 2963 mL. All patients received a blood transfusion with a median blood infusion volume of 2162 mL. Two patients with Budd-Chiari syndrome developed postoperative ascites and hydrothorax due to non-watertight repair of the diaphragm. During a follow-up of 11 to 44 months, only one patient died of liver metastasis and four patients developed distant metastasis without recurrence in the IVC.

Conclusions: The modified transabdominal approach described herein has an encouraging safety profile and provides a surgical option for treatment of RCC with a supradiaphragmatic IVC-TT. More evidence concerning the beneficial role of this procedure will be elucidated in further studies.

References

Glazer A, Novick A . Long-term followup after surgical treatment for renal cell carcinoma extending into the right atrium. J Urol. 1996; 155(2):448-50. View

Blute M, Leibovich B, Lohse C, Cheville J, Zincke H . The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int. 2004; 94(1):33-41. DOI: 10.1111/j.1464-410X.2004.04897.x. View

Bassi P, Dal Moro F, Ciaccia M, Rea F, Pagano F . Transdiaphragmatic-intrapericardiac approach to supradiaphragmatic vena cava invasion secondary to renal cell carcinoma: a novel surgical approach. Urology. 2005; 66(5):1101-5. DOI: 10.1016/j.urology.2005.05.046. View

Pringle J . V. Notes on the Arrest of Hepatic Hemorrhage Due to Trauma. Ann Surg. 1908; 48(4):541-9. PMC: 1406963. DOI: 10.1097/00000658-190810000-00005. View

Kaag M, Toyen C, Russo P, Cronin A, Thompson R, Schiff J . Radical nephrectomy with vena caval thrombectomy: a contemporary experience. BJU Int. 2010; 107(9):1386-93. PMC: 4315148. DOI: 10.1111/j.1464-410X.2010.09661.x. View

Abel E, Thompson R, Margulis V, Heckman J, Merril M, Darwish O . Perioperative outcomes following surgical resection of renal cell carcinoma with inferior vena cava thrombus extending above the hepatic veins: a contemporary multicenter experience. Eur Urol. 2013; 66(3):584-92. DOI: 10.1016/j.eururo.2013.10.029. View

Schneider M, Hadaschik B, Hallscheidt P, Jakobi H, Fritz M, Motsch J . Manual repositioning of intra-atrial kidney cancer tumor thrombus: a technique reducing the need for cardiopulmonary bypass. Urology. 2013; 81(4):909-14. DOI: 10.1016/j.urology.2012.10.064. View

Szeto C, Chow K . Pathogenesis and management of hydrothorax complicating peritoneal dialysis. Curr Opin Pulm Med. 2004; 10(4):315-9. DOI: 10.1097/01.mcp.0000127901.60693.d0. View

Sidana A, Goyal J, Aggarwal P, Verma P, Rodriguez R . Determinants of outcomes after resection of renal cell carcinoma with venous involvement. Int Urol Nephrol. 2012; 44(6):1671-9. DOI: 10.1007/s11255-012-0314-x. View

10.

Ciancio G, Shirodkar S, Soloway M, Livingstone A, Barron M, Salerno T . Renal carcinoma with supradiaphragmatic tumor thrombus: avoiding sternotomy and cardiopulmonary bypass. Ann Thorac Surg. 2010; 89(2):505-10. DOI: 10.1016/j.athoracsur.2009.11.025. View

11.

Mitchell M, Boitnott J, Kaufman S, Cameron J, Maddrey W . Budd-Chiari syndrome: etiology, diagnosis and management. Medicine (Baltimore). 1982; 61(4):199-218. DOI: 10.1097/00005792-198207000-00001. View

12.

Ali A, Vasdev N, Shanmuganathan S, Paez E, Dark J, Manas D . The surgical management and prognosis of renal cell cancer with IVC tumor thrombus: 15-years of experience using a multi-specialty approach at a single UK referral center. Urol Oncol. 2011; 31(7):1298-304. DOI: 10.1016/j.urolonc.2011.11.001. View

13.

Klein E, Kaye M, Novick A . Management of renal cell carcinoma with vena caval thrombi via cardiopulmonary bypass and deep hypothermic circulatory arrest. Urol Clin North Am. 1991; 18(3):445-7. View

14.

Cost N, Delacroix Jr S, Sleeper J, Smith P, Youssef R, Chapin B . The impact of targeted molecular therapies on the level of renal cell carcinoma vena caval tumor thrombus. Eur Urol. 2011; 59(6):912-8. DOI: 10.1016/j.eururo.2011.02.032. View

15.

Reese A, Whitson J, Meng M . Natural history of untreated renal cell carcinoma with venous tumor thrombus. Urol Oncol. 2012; 31(7):1305-9. DOI: 10.1016/j.urolonc.2011.12.006. View

16.

Staehler G, Brkovic D . The role of radical surgery for renal cell carcinoma with extension into the vena cava. J Urol. 2000; 163(6):1671-5. View

17.

Nguyen H, Tilki D, DallEra M, Durbin-Johnson B, Carballido J, Chandrasekar T . Cardiopulmonary Bypass has No Significant Impact on Survival in Patients Undergoing Nephrectomy and Level III-IV Inferior Vena Cava Thrombectomy: Multi-Institutional Analysis. J Urol. 2015; 194(2):304-308. PMC: 5012645. DOI: 10.1016/j.juro.2015.02.2948. View