En-Block resection of Renal Cell Carcinoma with tumour thrombus propagating into the intrapericardial Inferior Vena Cava: A transabdominal approach.

Background : Renal cell carcinoma (RCC) is the most common primary kidney cancer. In up to 4-10% of patients, the tumor is complicated with malignant thrombus extending to the inferior vena cava (IVC). Complete surgical excision of the RCC and the neoplastic thrombus can be curative. We aim to present a safe alternative transabdominal operative technique applied in six patients diagnosed with RCC and IVC thrombus. Methods: This retrospective analysis was conducted in a tertiary academic center in Athens, Greece. All six patients, that were operated for RCC and level-IV malignant thrombus in our department from January 2009 until March 2020, were screened. Intraoperatively, the infrarenal and intrapericardial IVC were clamped simultaneously with the renal and liver blood inflow. Access to the intrapericardial IVC was obtained via the central tendon of the diaphragm. Results: During the study period 6 patients presented with RCC and level-IV IVC thrombus. All patients underwent radical nephrectomy combined with IVC thrombectomy, without the need for a thoracotomy. Operative and hospital mortality was 0%. Conclusions : The proposed surgical technique may be curative in patients with advanced intracaval thrombus and helps reduce the associated morbidity, mortality, and the overall cost of more extended operations.