Key result
Precise IVC control without bypass safely manages level III RCC tumour thrombus with 0 perioperative deaths.
Why the study?
Does precise control of IVC and hepatic vessels without vascular bypass improve surgical safety in patients with level III IVC tumor thrombus concomitant to RCC?
Observational (n=5)
No
Does precise control of IVC and hepatic vessels without vascular bypass improve surgical safety in patients with level III IVC tumor thrombus concomitant to RCC?
Precise control of IVC and hepatic pedicle vessels without vascular bypass is a safe and effective surgical technique for level III tumor thrombus below the hepatic vein concomitant to RCC.
Supports bypass-free control in select level III cases; hypothesis-generating and should not yet change practice.
INTRODUCTION: We investigated the surgical techniques, safety, and prevention of complications of nephrectomy and removal of tumour thrombus for treating level III inferior vena cava (IVC) concomitant to renal cell carcinoma (RCC). We did this by precise controlling IVC and hepatic vessels without a vascular bypass. METHODS: In this series, we included 5 patients with level III IVC tumour thrombus below the hepatic vein concomitant to RCC. After precisely controlling the IVC and hepatic vessels, we then removed the thrombus en bloc with the renal vein. Blood loss volume, IVC clamping time, hypotension time, resuscitation, cardiocerebrovascular complications, and postoperative organ dysfunction were observed. RESULTS: Surgery was successfully performed without perioperative death. Blood loss volume was 900 to 1500 mL, operation time was 165 to 250 minutes, vascular clamping time was 8 to 12 minutes, and intraoperative hypotension time was 9 to 12 minutes. Serious perioperative complications were not observed. Local recurrence was not observed during the 9 to 24 months of follow-up. One patient exhibited disease-free survival, 3 developed lung or liver metastasis, and 1 died 11 months after surgery. CONCLUSION: Precise control of IVC and hepatic pedicle vessels, without vascular bypass, is a safe and effective surgical treatment for level III tumor thrombus below the hepatic vein concomitant to RCC. The procedure was conducted without increased risks of intraoperative hypotensive shock, difficult resuscitation, pulmonary embolism, and multiple organ dysfunctions.
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Chen et al. (2015) conducted an observational in Level III IVC tumour thrombus below the hepatic vein concomitant to renal cell carcinoma (n=5). Precise control of IVC and hepatic vessels without vascular bypass was evaluated on Perioperative death and serious complications. Precise control of IVC and hepatic pedicle vessels without vascular bypass was safely performed in 5 patients with level III IVC tumour thrombus concomitant to RCC, with no perioperative deaths.
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