Liver transplantation techniques with preservation of the natural venovenous bypass: Effect on surgical resection of renal cell carcinoma invading the inferior vena cava

Spiros Delis, Christos Dervenis, Dimitrios Lytras, Costas Avgerinos, Mark Soloway, Gaetano Ciancio

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Abstract

Although renal tumors invading the inferior vena cava (IVC) are unusual, they represent a challenge to the surgical team because their accessibility is difficult. Liver transplantation techniques have been developed that preserve the venous collaterals, enhance the exposure, increase the safety of the resection, and avoid cardiopulmonary bypass. We describe our technique for dealing with renal tumors that have invaded the IVC, a combined experience of two centers, and the safety of the procedure and subsequent low morbidity. Between May 1997 and February 2003, a total of 45 patients (mean age 60.7 years) underwent surgical resection of a renal tumor extending into the IVC by techniques developed from liver transplantation, with the intention to avoid sternotomy and cardiopulmonary bypass. In 42 patients (93.3%) surgical resection of the tumor and thrombus was successful using the transabdominal approach while preserving the venous collaterals; 3 patients with a level IV tumor thrombus required cardiopulmonary bypass. The mean operating time was 342 minutes, and the mean estimated blood loss was 1442 cc. Postoperative ileus in one patient required laparoscopic lysis of the adhesions, and 2 patients (4.4%) died owing to multiple system organ failure and massive pulmonary embolism. The median follow-up was 36 months, during which time 6 patients developed metastatic disease and 37 were disease-free. We concluded that liver transplantation techniques enhance the surgical management of complicated urologic tumors. Patients with tumor thrombus extending to the IVC can be treated while avoiding thoracotomy and cardiopulmonary bypass.

Original languageEnglish
Pages (from-to)614-619
Number of pages6
JournalWorld Journal of Surgery
Volume28
Issue number6
StatePublished - Jun 1 2004

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Inferior Vena Cava
Renal Cell Carcinoma
Liver Transplantation
Cardiopulmonary Bypass
Neoplasms
Thrombosis
Kidney
Safety
Sternotomy
Multiple Organ Failure
Ileus
Thoracotomy
Pulmonary Embolism
Morbidity

ASJC Scopus subject areas

  • Surgery

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Liver transplantation techniques with preservation of the natural venovenous bypass : Effect on surgical resection of renal cell carcinoma invading the inferior vena cava. / Delis, Spiros; Dervenis, Christos; Lytras, Dimitrios; Avgerinos, Costas; Soloway, Mark; Ciancio, Gaetano.

In: World Journal of Surgery, Vol. 28, No. 6, 01.06.2004, p. 614-619.

Research output: Contribution to journalArticle

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