Document Type
Article
Department
Cardiothoracic Surgery
Abstract
Objective:
To assess surgical strategies and the impact of a multidisciplinary approach on patients undergoing inferior vena caval thrombectomy for renal cell carcinoma and to evaluate perioperative morbidity and mortality associated with these procedures.
Methodology:
A retrospective audit for all adults who underwent nephrectomy and inferior vena caval thrombectomy from January 2008 till November 2018 at a University hospital. Patients with incomplete records were excluded from the study.
Results:
During the study period, 21 patients underwent inferior vena caval thrombectomy as a completion of radical nephrectomy. Most were males (19 : 2) with a mean age of 54±11.3 years. The most common surgical approach was the 11th rib flank approach (n=8) followed by midline abdominal (n=6) and Mercedes-Benz (n=5). Eight patients had level 1, 10 patients had level 2, and three patients had level 3 tumour thrombus. The cavotomy was closed primarily in 20 patients; one required inferior vena cava (IVC) reconstruction with a pericardial patch. The proximal clamp was applied below the hepatic veins for most patients. Two patients required suprahepatic clamping before thrombectomy. There was no intraoperative mortality. Five patients (24%) developed complications: two required cardiopulmonary resuscitation due to severe hypotension and were revived; one developed acute renal failure; and one patient required a damage control laparotomy for excessive oozing. There was no thirty-day mortality. Conclusion: The IVC thrombectomy, along with radical nephrectomy for renal cell carcinoma for 1-3 level thrombus, can be performed with acceptable morbidity in a multidisciplinary team approach.
Publication (Name of Journal)
Annals of vascular diseases
Recommended Citation
Rehman, Z.,
Ather, H.,
Aziz, W.
(2019). Surgical interventions for renal cell carcinoma with thrombus extending into the inferior vena cava: A multidisciplinary approach. Annals of vascular diseases, 12(1), 55-59.
Available at:
https://ecommons.aku.edu/pakistan_fhs_mc_surg_cardiothoracic/150