Modified liver mobilization for the treatment of renal cell carcinoma with thrombosis involving the intrahepatic inferio
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RESEARCH
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Modified liver mobilization for the treatment of renal cell carcinoma with thrombosis involving the intrahepatic inferior vena cava Zhijian Han, Changjun Yin*, Xiaoxin Meng, Qiang Lu, Xiaobing Ju, Jie Li, Chao Qin, Pengfei Shao, Rijin Song, Pei Lu, Bianjiang Liu, Jiexiu Zhang and Min Gu
Abstract Background: We aimed to evaluate the feasibility and clinical significance of using a modified liver-mobilization technique to treat renal cell carcinoma (RCC) combined with intrahepatic inferior vena cava (IVC) thrombosis. Methods: A total of 11 level III thrombus patients underwent radical nephrectomy with resection of the tumor thrombus from intrahepatic IVC. A father clamp was used in combination with hepatic portal blocking to control the IVC. Results: The intraoperative mortality and postoperative complications were reduced in 11 cases of RCC with intrahepatic IVC thrombosis. The mean blood loss was 800 mL, and mean patient hospital stay was 13 days. Follow-up was conducted for one to four months, with only two cases of recurrence recorded. Conclusions: The proposed modified liver-mobilization technique could safely and effectively treat RCC and reduce intrahepatic IVC thrombosis. Keywords: Renal cell carcinoma, Modified liver-mobilization technique, Thrombosis, Intrahepatic inferior vena cava, Father clamp
Background Inferior vena cava (IVC) involvement is present in 4 to 15% of patients with renal cancer carcinomas (RCC) [1]. The IVC involvement may be in the form of blood clots alone or as a combination of blood clots and tumor tissues. The invasion of the IVC wall occurs in 43 to 64% of tumor cases [2,3]. To date, the surgical removal of the kidney and the IVC thrombus are the only known methods to cure these tumors. A five-year survival rate of 30 to 70% can be achieved with such patients, in the absence of lymph node invasion or distant metastasis [4-6]. The level of IVC involvement has little effect on the survival rate of patients undergoing complete resection [7-9]. Our laboratory has been using liver transplant techniques to resect tumors and IVC thrombosis for the past 15 years. In the present study we used a modified liver-mobilization technique to treat 11 cases of RCC * Correspondence: [email protected] Department of Urology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
with intrahepatic IVC thrombosis, without opening the chest cavity or blocking the supradiaphragmatic IVC. The patients with RCC and IVC involvement were evaluated based on their clinical features, diagnostic modalities, surgical approaches, perioperative mortality, perioperative morbidity, and long-term outcomes.
Methods The study was approved by the Institutional Review Board of the Nanjing Medical University, Nanjing, China. To treat the IVC thrombus, a subcostal incision of approximately the width of two fingers was made below the right costal margin and laterally extended to the midaxillary line. A framed self-reta
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