The use of liver transplant techniques to aid in the surgical management of urological tumors

Gaetano Ciancio, Christopher Hawke, Mark Soloway

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

Purpose: Inferior vena cava tumor thrombus complicates radical nephrectomy. Various approaches have been used to deal with this problem, including venovenous and cardiopulmonary bypass. Applying organ transplant techniques enhances the exposure of urological tumors and may avoid bypass. Materials and Methods: A total of 26 patients underwent surgery by techniques developed to facilitate orthotopic liver transplantation. Of the patients 15 with renal cell carcinoma and an intracaval tumor thrombus underwent piggyback style mobilization of the liver off of the retrohepatic inferior vena cava to allow enhanced access and vascular control, while 11 underwent conventional mobilization of the liver and retrohepatic inferior vena cava en bloc to allow enhanced access to various renal, adrenal and retroperitoneal tumors. Results: In the 11 patients surgery was successful with a median blood loss of 200 ml. Postoperative ileus in i case was the only complication. We resected 5 infrahepatic thrombi without complications and with a median blood loss of 500 ml. In 7 patients with a retrohepatic inferior vena caval thrombus median blood loss was 1,500 ml., including i who died postoperatively, presumably due to a massive pulmonary embolus. Caval atrial tumor thrombus in 3 cases was successfully removed via a completely abdominal approach and sternotomy in 2. Cardiopulmonary bypass with hypothermic circulatory arrest was required in i of these cases. Conclusions: Liver mobilization was helpful for managing difficult urological tumors. Patients with a retrohepatic or even suprahepatic inferior vena caval thrombus may be treated without sternotomy or thoracotomy and cardiopulmonary bypass.

Original languageEnglish
Pages (from-to)665-672
Number of pages8
JournalJournal of Urology
Volume164
Issue number3 I
StatePublished - Sep 1 2000

Fingerprint

Thrombosis
Transplants
Venae Cavae
Liver
Inferior Vena Cava
Cardiopulmonary Bypass
Neoplasms
Sternotomy
Ileus
Thoracotomy
Embolism
Nephrectomy
Renal Cell Carcinoma
Liver Transplantation
Blood Vessels
Kidney
Lung

Keywords

  • Inferior
  • Kidney
  • Liver transplantation
  • Neoplasms
  • Nephrectomy
  • Vena cava

ASJC Scopus subject areas

  • Urology

Cite this

The use of liver transplant techniques to aid in the surgical management of urological tumors. / Ciancio, Gaetano; Hawke, Christopher; Soloway, Mark.

In: Journal of Urology, Vol. 164, No. 3 I, 01.09.2000, p. 665-672.

Research output: Contribution to journalArticle

Ciancio, Gaetano ; Hawke, Christopher ; Soloway, Mark. / The use of liver transplant techniques to aid in the surgical management of urological tumors. In: Journal of Urology. 2000 ; Vol. 164, No. 3 I. pp. 665-672.
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