Xeno‐pericardial patch repair of the inferior vena cava for radical resection of renal cell carcinoma with tumor thrombus

Figures

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  Figure 1. The tip of the tumor thrombus and the area of the IVC wall that was adhered by the tumor thrombus was examined direct ultrasonography study, by which final decision was made to select one of the three surgical procedures. Incision of the IVC was started in the tumor‐free IVC wall at the level of the renal vein, and extended longitudinally to identify the tips of the tumor thrombus with 5 mm tumor‐free margin remaining in the IVC wall

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  Figure 2. (A) The inferior vena cava (IVC) was repaired by glutaraldehyde‐treated bovine pericardial patch after the removal of IVC tumor thrombus under the view of liver mobilization. (B) The tumor was removed en bloc including the tumor‐thrombus and the diseased kidney

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  Figure 3. (A) In the cases in which the tip of the tumor thrombus was present below the stem of the hepatic veins, the clamps were placed on the infrahepatic inferior vena cava (IVC), the infrarenal IVC, and the left renal vein, with or without clamp on the left renal artery, to expose the IVC that was longitudinally incised under minimum time of kidney ischemia without liver ischemia (The Procedure I). (B) In the cases in which the tip of the tumor thrombus was present in the intrahepatic IVC, the clamps were placed in the suprahepatic IVC, the hepatic veins, the infrarenal IVC, and the left renal artery/vein to expose the IVC that was longitudinally incised under the liver and the kidney ischemia (The Procedure II). Median sternotomy may be added depending upon the exposure of the suprahepatic IVC. (C) In the cases in which the tumor thrombus was present in the right atrium, extracorporeal circulation with mild hypothermia was established to expose the IVC and the right atrium that was longitudinally incised under induced ischemia in the liver and the left kidney (The Procedure III)