Results of endoluminal occlusion of the inferior vena cava during radical nephrectomy and thrombectomy

Eur Urol. 2008 Oct;54(4):778-83. doi: 10.1016/j.eururo.2008.05.016. Epub 2008 May 27.

Abstract

Background: The surgical management of renal tumours with thrombi in the inferior vena cava (IVC) has become the gold standard treatment.

Objective: To evaluate endoluminal occlusion of the IVC during radical nephrectomy with either retrohepatic (level II) or suprahepatic (level III) caval tumour thrombus.

Design, setting, and participants: From January 2000 to October 2007, 28 consecutive patients with renal cell carcinoma presenting a thrombus level II or III were treated with endoluminal occlusion of the free IVC cranial.

Surgical procedure: The occlusion balloon was positioned under transesophageal echography (TEE) control through a cavotomy performed at the level of the renal vein ostium. Thrombectomy and radical nephrectomy were then performed.

Measurements: Operative time, perioperative bleeding, and pre- and postoperative complications were assessed. Overall patient survival time, disease-free survival, and development of metastasis were assessed.

Results and limitations: Caval thrombectomy was performed successfully in all patients. IVC replacement with an expanded polytetrafluoroethylene graft or patch closure after lateral cavectomy was performed in 10 and 4 patients, respectively. Average operative time was 160 min (range: 120-210). There was no perioperative mortality. The complications were one splenectomy and one early thrombosis of the IVC. Mean length of follow-up was 22.1 mo (range: 3-90). There was no local or IVC tumour recurrence. Cause-specific death and metastasis occurred in six (21.4%) and nine patients (32.1%), respectively. Thirteen patients (46.4%) are disease-free.

Conclusions: Endoluminal occlusion of the IVC with TEE monitoring for level II and III thrombus avoided a suprahepatic or subdiaphragmatic approach of the IVC. Segmental resection and reconstruction of the IVC could also be performed in case of adherent thrombi.

MeSH terms

  • Adult
  • Aged
  • Balloon Occlusion*
  • Carcinoma, Renal Cell / secondary*
  • Carcinoma, Renal Cell / surgery*
  • Female
  • Humans
  • Kidney Neoplasms / pathology*
  • Kidney Neoplasms / surgery*
  • Male
  • Middle Aged
  • Neoplastic Cells, Circulating*
  • Nephrectomy*
  • Thrombectomy / methods*
  • Vena Cava, Inferior*
  • Young Adult