Surgical techniques for treating a renal neoplasm invading the inferior vena cava

Anil Vaidya, Gaetano Ciancio, Mark Soloway

Research output: Contribution to journalArticle

83 Citations (Scopus)

Abstract

Purpose: Historically inferior vena caval thrombus associated with renal cell carcinoma was a deterrent to surgery. During the last 3 decades there has been steady improvement in surgical techniques and perioperative care, which has dramatically improved the ability to resect safely these tumors. We acknowledge these improvements in chronological order. Materials and Methods: A comprehensive literature review of the different techniques used for resecting renal cell carcinoma with inferior vena caval involvement was performed using MEDLINE. Data focused on surgical techniques, including various incisions, exposures, adjuncts to surgery and outcomes. Results: Tumor thrombus associated with renal cell carcinoma is no longer considered to have a detrimental impact on survival. Patients who are acceptable surgical candidates have survival rates as high as 68%. Although there is a great deal of emphasis on the importance of an aggressive surgical approach, a uniform operative strategy based on the level of the tumor thrombus has not been established. Surgical techniques derived from liver transplant surgery and cardiac arrest with cardiopulmonary bypass have drastically decreased operative complications associated with extensive involvement of the inferior vena cava with tumor thrombus. Conclusions: The only curative approach to renal cell carcinoma is surgery. An aggressive approach is warranted when tumor involves the renal vein and inferior vena cava. Surgical strategy depends on the level of the inferior vena caval thrombus. Patients with extension of the thrombus above the diaphragm are a greater technical challenge. Hypothermic circulatory arrest should be considered when treating vena caval-atrial tumor thrombus. Surgeons familiar with liver mobilization can greatly facilitate the exposure needed for safely operating in these cases.

Original languageEnglish
Pages (from-to)435-444
Number of pages10
JournalJournal of Urology
Volume169
Issue number2
DOIs
StatePublished - Feb 1 2003

Fingerprint

Kidney Neoplasms
Inferior Vena Cava
Thrombosis
Venae Cavae
Renal Cell Carcinoma
Neoplasms
Perioperative Care
Renal Veins
Liver
Diaphragm
Heart Arrest
Cardiopulmonary Bypass
MEDLINE
Survival Rate
Transplants
Survival

Keywords

  • Kidney
  • Kidney neoplasms
  • Vena cava, inferior
  • Venous thrombosis

ASJC Scopus subject areas

  • Urology

Cite this

Surgical techniques for treating a renal neoplasm invading the inferior vena cava. / Vaidya, Anil; Ciancio, Gaetano; Soloway, Mark.

In: Journal of Urology, Vol. 169, No. 2, 01.02.2003, p. 435-444.

Research output: Contribution to journalArticle

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