Top

World Journal of Surgery

Published in:

01-05-2015 | Original Scientific Report

Clinical Outcomes Related to the Level of Clamping in Inferior Vena Cava Surgery

Authors: Heungman Jun, Youngjin Han, Hojong Park, Sung Shin, Yong-Pil Cho, Tae-Won Kwon

Published in: World Journal of Surgery | Issue 5/2015

Abstract

Objective

In most cases of inferior vena cava (IVC) surgery, IVC clamping is required owing to several factors, including renal cell carcinoma with IVC thrombus extension and IVC leiomyosarcoma. Various clinical results were compared following IVC clamping by classifying clamping levels into juxtarenal, infrahepatic, and suprahepatic. In particular, the risk factors of postoperative thrombosis after IVC clamping were assessed comparatively.

Methods

Eighty-four patients who underwent IVC clamping owing to IVC pathology between 2002 and 2012 were retrospectively reviewed with regard to RBC transfusion, operation time, clamping time, liver and kidney functions, duration of hypotension, blood pressure (BP) drops, pulmonary thromboembolism (PTE), venous thrombosis, ICU stay duration, hospital stay duration, 30-day morbidity, and 30-day mortality. In addition, various clinical results were compared when postoperative thrombosis occurred after IVC clamping.

Results

Values for operation time, clamping time, units of RBC transfused, duration of hypotension, severity of BP drops, use of cardiopulmonary bypass (CPB), aspartate aminotransferase, the use of inotropes, IVC patency, ICU stay, and hospital stay duration were significantly higher in the suprahepatic clamping group than in the other clamping groups. In addition, CPB use and IVC clamping level were significant risk factors for postoperative thrombosis after IVC clamping.

Conclusions

Although IVC clamping is a prerequisite for IVC surgery, operative durations, units of RBC transfused, and length of hospital stays increase with higher clamping levels. In addition, CPB use and IVC clamping level are significant risk factors for postoperative thrombosis. In IVC surgery with higher clamping levels, prompt hemodynamic support and proper anticoagulation therapy are important.

Kwon TW, Sung KB, Cho YP, Kim DK, Yang SM, Ro JY et al (2003) Pararenal leiomyosarcoma of the inferior vena cava. J Korean Med Sci 18:355–359CrossRefPubMedCentralPubMed

Shuch B, Larochelle JC, Onyia T, Vallera C, Margulis D, Pantuck AJ et al (2009) Intraoperative thrombus embolization during nephrectomy and tumor thrombectomy: critical analysis of the University of California-Los Angeles experience. J Urol 181:492–498 discussion 8–9CrossRefPubMed

Neves RJ, Zincke H (1987) Surgical treatment of renal cancer with vena cava extension. Br J Urol 59:390–395CrossRefPubMed

Kwon TW, Kim H, Moon KM, Cho YP, Song C, Kim CS et al (2010) Surgical treatment of inferior vena cava tumor thrombus in patients with renal cell carcinoma. J Korean Med Sci 25:104–109CrossRefPubMedCentralPubMed

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedCentralPubMed

Wang GJ, Carpenter JP, Fairman RM, Jackson BM, Malkowicz B, Van Arsdalen KN et al (2008) Single-center experience of caval thrombectomy in patients with renal cell carcinoma with tumor thrombus extension into the inferior vena cava. Vasc Endovascular Surg 42:335–340CrossRefPubMed

Rahbari NN, Koch M, Zimmermann JB, Elbers H, Bruckner T, Contin P et al (2011) Infrahepatic inferior vena cava clamping for reduction of central venous pressure and blood loss during hepatic resection: a randomized controlled trial. Ann Surg 253:1102–1110CrossRefPubMed

Zhu P, Lau WY, Chen YF, Zhang BX, Huang ZY, Zhang ZW et al (2012) Randomized clinical trial comparing infrahepatic inferior vena cava clamping with low central venous pressure in complex liver resections involving the Pringle manoeuvre. Br J Surg 99:781–788CrossRefPubMed

Otsubo T, Takasaki K, Yamamoto M, Katsuragawa H, Katagiri S, Yoshitoshi K et al (2004) Bleeding during hepatectomy can be reduced by clamping the inferior vena cava below the liver. Surgery 135:67–73CrossRefPubMed

10.

Kieffer E, Alaoui M, Piette JC, Cacoub P, Chiche L (2006) Leiomyosarcoma of the inferior vena cava: experience in 22 cases. Ann Surg 244:289–295CrossRefPubMedCentralPubMed

11.

Illuminati G, Calio FG, D’Urso A, Giacobbi D, Papaspyropoulos V, Ceccanei G (2006) Prosthetic replacement of the infrahepatic inferior vena cava for leiomyosarcoma. Arch Surg 141:919–924 discussion 24CrossRefPubMed

12.

Vaidya A, Ciancio G, Soloway M (2003) Surgical techniques for treating a renal neoplasm invading the inferior vena cava. J Urol 169:435–444CrossRefPubMed

13.

Klein EA, Kaye MC, Novick AC (1991) Management of renal cell carcinoma with vena caval thrombi via cardiopulmonary bypass and deep hypothermic circulatory arrest. Urol Clin North Am 18:445–447PubMed

14.

Novick AC, Kaye MC, Cosgrove DM, Angermeier K, Pontes JE, Montie JE et al (1990) Experience with cardiopulmonary bypass and deep hypothermic circulatory arrest in the management of retroperitoneal tumors with large vena caval thrombi. Ann Surg 212:472–476 discussion 6-7CrossRefPubMedCentralPubMed

15.

Nesbitt JC, Soltero ER, Dinney CP, Walsh GL, Schrump DS, Swanson DA et al (1997) Surgical management of renal cell carcinoma with inferior vena cava tumor thrombus. Ann Thorac Surg 63:1592–1600CrossRefPubMed

16.

Stewart JR, Carey JA, McDougal WS, Merrill WH, Koch MO, Bender HW Jr (1991) Cavoatrial tumor thrombectomy using cardiopulmonary bypass without circulatory arrest. Ann Thorac Surg 51:717–721 discussion 21-2CrossRefPubMed

17.

Langenburg SE, Blackbourne LH, Sperling JW, Buchanan SA, Mauney MC, Kron IL et al (1994) Management of renal tumors involving the inferior vena cava. J Vasc Surg 20:385–388CrossRefPubMed

18.

Ringe B, Bornscheuer A, Blumhardt G, Bechstein WO, Wonigeit K, Pichlmayr R (1987) Experience with veno-venous bypass in human liver transplantation. Transplant Proc 19:2416PubMed

19.

Oikawa T, Shimazui T, Johraku A, Kihara S, Tsukamoto S, Miyanaga N et al (2004) Intraoperative transesophageal echocardiography for inferior vena caval tumor thrombus in renal cell carcinoma. Int J Urol 11:189–192CrossRefPubMed

20.

Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H (2004) The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int 94:33–41CrossRefPubMed

Title: Clinical Outcomes Related to the Level of Clamping in Inferior Vena Cava Surgery
Authors: Heungman Jun
Youngjin Han
Hojong Park
Sung Shin
Yong-Pil Cho
Tae-Won Kwon
Publication date: 01-05-2015
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 5/2015
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-015-2957-0

2024 ASCO Annual Meeting

Springer Medicine

Clinical Outcomes Related to the Level of Clamping in Inferior Vena Cava Surgery

Abstract

Objective

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2015

Changing Operative Strategy from Abdominoperineal Resection to Sphincter Preservation in T3 Low Rectal Cancer after Downstaging by Neoadjuvant Chemoradiation: A Preliminary Report

Liver Function Following Extended Hepatectomy Can Be Accurately Predicted Using Remnant Liver Volume to Body Weight Ratio

Two-Day Hospital Stay After Laparoscopic Colorectal Surgery, is Enhanced Recovery Program a Healthcare System Specific Issue?: Reply

Long-Term Outcomes After Total Pancreatectomy: Special Reference to Survivors’ Living Conditions and Quality of Life

Postoperative Hyperbilirubinemia Suggests the Occurrence of Complications After Esophagectomy for Esophageal Cancer

Welcome Associate Editor Danny Rosin