Surgical Tips for Inferior Vena Cava Thrombectomy
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SURGERY (M DESAI, SECTION EDITOR)
Surgical Tips for Inferior Vena Cava Thrombectomy Alireza Ghoreifi 1 & Hooman Djaladat 1 Accepted: 15 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The aim of this review is to describe the preoperative evaluation, surgical techniques, and postoperative management of patients with renal cell carcinoma (RCC) undergoing radical nephrectomy (RN) and inferior vena cava (IVC) thrombectomy. Recent Findings RN and IVC thrombectomy remains the standard management option in non-metastatic RCC patients with IVC thrombus. A comprehensive preoperative workup, including high-quality imaging, blood works, and appropriate consultations are required for all patients. The aim of the surgery is complete resection of all tumor burden, which requires a skillful surgical team for such a challenging procedure and is inherently associated with a high rate of perioperative morbidity and mortality. Summary Preoperative CT or MRI is essential for surgical planning. The surgical approach is mainly determined by the level of the tumor thrombus. The open approach has been the standard, though minimally invasive and robotic techniques are emerging in selected cases by experienced surgeons. Keywords Renal cell carcinoma . Inferior vena cava . Thrombus . Thrombectomy
Introduction Involvement of renal vein or inferior vena cava (IVC) is seen in up to 10% of the renal cell carcinoma (RCC) cases, of which 1% extends to the right atrium [1]. Tumor thrombus is a significant adverse prognostic factor in these patients, and the thrombus level is an independent predictor of survival [2]. The 1-year disease-specific survival of untreated RCC with venous tumor thrombus is 29% that improves significantly following radical nephrectomy (RN) and venous thrombectomy [3, 4]. Ciancio et al. reported a 5-year disease-free survival of 64% in RCC patients with any level of IVC thrombus following surgery [5]. The survival rate has been improving in recent years with the introduction of novel therapeutic agents. However, aggressive surgical resection remains the default management option in non-metastatic RCC patients with IVC thrombus, irrespective of the thrombus level [6, 7]. It is a challenging procedure with high difficulty and This article is part of the Topical Collection on Surgery * Hooman Djaladat [email protected] 1
Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave. Suite 7416, Los Angeles, CA 90089, USA
potential mortality. Surgical approach for the IVC thrombectomy varies mainly based on the thrombus level and the surgeon’s experience. These complex surgeries require an excellent experience of a multi-disciplinary team including urologists and anesthesiologists, as well as cardiothoracic and vascular surgeons in selected cases. In this report, we describe the preoperative evaluation, surgical techniques, and postoperative considerations of patients with RCC undergoing RN and IVC thrombectomy.
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