» Articles » PMID: 37667821

Technical Tips for Performing Suprahepatic Vena Cava Tumor Thrombectomy in Renal Cell Carcinoma Without Using Cardiopulmonary Bypass

Overview
Date 2023 Sep 5
PMID 37667821
Authors
Affiliations
Soon will be listed here.
Abstract

Radical nephrectomy with tumor thrombectomy for advanced renal cell carcinoma is an oncologically relevant approach that can achieve long-term survival even in the presence of distant metastases. However, the surgical techniques pose significant challenges. The objective of this clinical review was to present technical recommendations for tumor thrombectomy in the vena cava to facilitate surgical treatment. Transesophageal echocardiography is required to prepare for this procedure. Cardiopulmonary bypass should be considered when the tumor thrombus has invaded the cardiac chamber and clamping is not feasible because of the inability to milk the intracardiac chamber thrombus in the caudal direction. Prior to performing a cavotomy, it is crucial to clamp the contralateral renal vein and infrarenal and suprahepatic inferior vena cava (IVC). If the suprahepatic IVC is separated from the surrounding tissue, it can be gently pulled down toward the patient's leg until the lower margin of the atrium becomes visible. Subsequently, the tumor thrombus should be carefully pulled downward to a position where it can be clamped. Implementing the Pringle maneuver to reduce blood flow from the hepatic veins to the IVC during IVC cavotomy is simpler than clamping the hepatic veins. Sequential clamping is a two-stage method of dividing thrombectomy by clamping the IVC twice, first suprahepatically and then midretrohepatically. This sequential clamping technique helps minimize hypotension status and the Pringle maneuver time compared to single clamping. Additionally, a spiral cavotomy can decrease the degree of primary closure narrowing. The oncological prognoses of patients can be improved by incorporating these technical recommendations.

Citing Articles

A novel technique for proximal inferior vena cava control during tumor thrombectomy using the COBRA-OS balloon.

Jenjitranant P, de Jesus Cendejas-Gomez J, Power A, Power N Can Urol Assoc J. 2024; 18(11):E350-E352.

PMID: 38976893 PMC: 11534402. DOI: 10.5489/cuaj.8772.


Renal cell carcinoma with an "uncoiling" tumor thrombus: intraoperative shift from level III to level IV.

Mata M, Tabbara M, Alvarez A, Gonzalez J, Ciancio G World J Surg Oncol. 2024; 22(1):76.

PMID: 38454471 PMC: 10918875. DOI: 10.1186/s12957-024-03355-z.

References
1.
Gocol R, Hudziak D, Bis J, Mendrala K, Morkisz L, Podsiadlo P . The Role of Deep Hypothermia in Cardiac Surgery. Int J Environ Res Public Health. 2021; 18(13). PMC: 8297075. DOI: 10.3390/ijerph18137061. View

2.
Lambert E, Pierorazio P, Shabsigh A, Olsson C, Benson M, McKiernan J . Prognostic risk stratification and clinical outcomes in patients undergoing surgical treatment for renal cell carcinoma with vascular tumor thrombus. Urology. 2007; 69(6):1054-8. DOI: 10.1016/j.urology.2007.02.052. View

3.
Jibiki M, Iwai T, Inoue Y, Sugano N, Kihara K, Hyochi N . Surgical strategy for treating renal cell carcinoma with thrombus extending into the inferior vena cava. J Vasc Surg. 2004; 39(4):829-35. DOI: 10.1016/j.jvs.2003.12.004. View

4.
Dellaportas D, Arkadopoulos N, Tzanoglou I, Bairamidis E, Gemenetzis G, Xanthakos P . Technical Intraoperative Maneuvers for the Management of Inferior Vena Cava Thrombus in Renal Cell Carcinoma. Front Surg. 2017; 4:48. PMC: 5592235. DOI: 10.3389/fsurg.2017.00048. View

5.
Abel E, Carrasco A, Karam J, Tamboli P, Delacroix S, Vaporciyan A . Positive vascular wall margins have minimal impact on cancer outcomes in patients with non-metastatic renal cell carcinoma (RCC) with tumour thrombus. BJU Int. 2013; 114(5):667-73. DOI: 10.1111/bju.12515. View