Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Current Urology Reports
Published in: Current Urology Reports 11/2014

01-11-2014 | Urosurgery (A Stenzl, Section Editor)

Caval Thrombus in Conjunction with Renal Tumors: Indication for Surgery and Technical Details

Authors: J. González, G. Ciancio

Published in: Current Urology Reports | Issue 11/2014

Login to get access

Abstract

Patients with locally advanced renal cell carcinoma require an aggressive surgical approach, as this strategy represents the only hope for curing the disease. Selection of the appropriate surgical technique to treat these cases is essential in order to achieve the best outcomes. This process usually entails a tailored approach centered on the individual disease features. This article reviews the indications and provides a technical description for each of the surgical steps commonly used to address the multiple possible scenarios in this context.
Literature
1.
Berg AA. Malignant hypernephroma of the kidney, its clinical course and diagnosis, with a description of the author’s method of radical operative cure. Surg Gynecol Obstet. 1913;17:463–71.
2.
Marshall VF, Middleton RG, Holswade GR, et al. Surgery for renal cell carcinoma in the vena cava. J Urol. 1970;103:414–20.PubMed
3.
Hatakeyama S, Yoneyama T, Hamano I, et al. Prognostic benefit of surgical management in renal cell carcinoma patients with thrombus extending to the renal vein and inferior vena cava: 17-year experience at a single center. BMC Urol. 2013;13:47.PubMedCrossRefPubMedCentral
4.•
Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H. The mayo clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumor thrombus. BJU Int. 2004;94:33–41. Excellent review on the technical aspects regarding surgery for RCC with IVC involvement from a high-referral institution.PubMedCrossRef
5.
Skinner DG, Pritchett TR, Lieskovsky G, Boyd SD, Stiles QR. Vena caval involvement by renal cell carcinoma. Surgical resection provides meaningful long-term survival. Ann Surg. 1989;210:387–94.PubMedCrossRefPubMedCentral
6.
Golimbu M, Joshi P, Sperber A, Tessier A, Al-Askari S, Morales P, et al. Renal cell carcinoma -Survival and prognostic factors. J Urol. 1986;27:291–30.CrossRef
7.
Zisman A, Pantuck AJ, Chao DH, Wieder JA, Dorey F, Said JW, et al. Renal cell carcinoma with tumor thrombus: is cytoreductive nephrectomy for advanced disease associated with an increased complication rate? J Urol. 2002;168:962–7.PubMedCrossRef
8.
Hatcher PA, Anderson EE, Paulson DF, Carson CC, Robertson JE. Surgical management and prognosis of renal cell carcinoma invading the vena cava. J Urol. 1991;145:20–4.PubMed
9.
Nesbitt JC, Soltero ER, Dinney CP. Surgical management of renal cell carcinoma with IVC tumor thrombus. Ann Thorac Surg. 1997;63:1592–600.PubMedCrossRef
10.
Sosa RE, Muecke EC, Vaughan Jr ED. Renal carcinoma extending into the inferior vena cava: the prognostic significance of the level of vena caval involvement. J Urol. 1984;132:1097–100.PubMed
11.
Boorjian SA, Sengupta S, Blute ML. Renal cell carcinoma: vena caval involvement. BJU Int. 2007;99:1239–44.PubMedCrossRef
12.
Kirkali Z, van Poppel H. A critical analysis of surgery for kidney cancer with vena cava invasion. Eur Urol. 2007;52:658–62.PubMedCrossRef
13.••
González J, Andrés G, Martínez-Salamanca JI, Ciancio G. Improving surgical outcomes in renal cell carcinoma involving the inferior vena cava. Expert Rev Anticancer Ther. 2013;13:1373–87. Review of the main factors determining surgical outcomes in RCC with IVC involvement and strategies on how to improve them.PubMedCrossRef
14.
Vincent C, Moorthy K, Sarker SK, Chang A, Darzi AW. Systems approaches for surgical quality and safety: from concept to measurement. Ann Surg. 2004;239:475–82.PubMedCrossRefPubMedCentral
15.
Klatte T, Pantuck AJ, Riggs SB, et al. Prognostic factors for renal cell carcinoma with tumor thrombus extension. J Urol. 2007;178:1189–95.PubMedCrossRef
16.
Martínez-Salamanca JI, Huang WC, Millán I, et al. Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension. Eur Urol. 2011;59:120–7.PubMedCrossRef
17.
Lambert EH, Pierorazio PM, Shabsigh A, et al. Prognostic risk stratification and clinical outcomes in patients undergoing surgical treatment for renal cell carcinoma with vascular tumor thrombus. Urology. 2007;69:1054–8.PubMedCrossRef
18.
Zini L, Destrieux-Garnier L, Leroy X, et al. Renal vein ostium wall invasion of renal cell carcinoma with an inferior vena cava tumor thrombus: prediction by renal and vena caval vein diameters and prognostic significance. J Urol. 2008;179:450–4. discussion 454.PubMedCrossRef
19.
Sidana A, Goyal J, Aggarwal P, Verma P, Rodriguez R. Determinants of outcomes after resection of renal cell carcinoma with venous involvement. Int Urol Nephrol. 2012;44:1671–9.PubMedCrossRef
20.
21.
Krajewski KM, Giardino AA, Zukotynski K, Van den Abbeele AD, Pedrosa I. Imaging in renal cell carcinoma. Hematol Oncol Clin N Am. 2011;25:687–715.CrossRef
22.
Kulkarni J, Jadhav Y, Valsangkar RS. IVC thrombectomy in renal cell carcinoma- analysis of outcome data of 100 patients and review of literature. Indian J Surg Oncol. 2012;3:103–7.CrossRef
23.•
Neves RJ, Zincke H. Surgical treatment of renal cancer with vena cava extension. Br J Urol. 1987;59(5):390–5. Classical system commonly used to categorize tumor thrombus anatomic level for surgical purposes.PubMedCrossRef
24.••
Gorin MA, González J, Garcia-Roig M, Ciancio G. Transplantation techniques for the resection of renal cell carcinoma with tumor thrombus: a technical description and review. Urol Oncol. 2013;31:1780–7. Excellent review of useful surgical transplantation techniques applied to RCC with IVC involvement.PubMedCrossRef
25.
Shuch B, Larochelle JC, Onyia T, et al. Intraoperative thrombus embolization during nephrectomy and tumor thrombectomy: critical analysis of the University of California-Los Angeles experience. J Urol. 2009;181:492–8. discussion 498-9.PubMedCrossRef
26.
Abel EJ, Wood CG, Eickstaedt N, et al. Preoperative pulmonary embolism does not predict poor postoperative outcomes in patients with renal cell carcinoma and venous thrombus. J Urol. 2013;190:452–7.PubMedCrossRef
27.
Ayyathurai R, Garcia-Roig M, Gorin MA, et al. Bland thrombus association with tumor thrombus: analysis of surgical significance and role of inferior vena cava interruption. BJU Int. 2012;110:E449–55.PubMedCrossRef
28.
Joshi S, Gorin MA, Ayyathurai R, Ciancio G. Development of a surgical safety checklist for the performance of radical nephrectomy and tumor thrombectomy. Patient Saf Surg. 2012;6:27–31.PubMedCrossRefPubMedCentral
29.
Konety BR, Allareddy V, Modak S, Smith B. Mortality after major surgery for urology cancer in specialised urology hospitals; are they any better? J Clin Oncol. 2006;24:2006–12.PubMedCrossRef
30.
Hollenbeek BK, Dunn RL, Miller DC, Diagnault S, Taub DA, Wei JT. Volume based referral for cancer surgery: informing debate. J Clin Oncol. 2007;25:91–6.CrossRef
31.
Calhoun JB, Merchen TD, Brown JA. Radical nephrectomy and inferior vena caval thrombectomy: outcomes in a lower volume practice. Can J Urol. 2011;18:5537–41.PubMed
32.
Hedderich GS, O’Connor RJ, Reid EC, Mulder DS. Caval tumor thrombus complicating renal cell carcinoma: a surgical challenge. Surgery. 1987;102:614–21.PubMed
33.
34.
Mueller-Lisse UG, Mueller-Lisse UL. Imaging of advanced renal cell carcinoma. World J Urol. 2010;28:253–61.PubMedCrossRef
35.
Guzzo TJ, Pierorazio PM, Schaeffer EM, et al. The accuracy of multidetector computerized tomography for evaluating tumor thrombus in patients with renal cell carcinoma. J Urol. 2009;181:486–91.PubMedCrossRef
36.
Loffroy R, Rao P, Ota S, Geschwind JF. Renal artery embolisation prior to radical nephrectomy for renal cell carcinoma: when, how and why? Br J Radiol. 2010;83:630. author reply 631-2.PubMedCrossRefPubMedCentral
37.
Subramanian VS, Stephenson AJ, Goldfarb DA, Fergany AF, Novick AC, Krishnamurthi V. Utility of preoperative renal artery embolization for management of renal tumors with inferior vena caval thrombi. Urology. 2009;74:154–9.PubMedCrossRef
38.•
Margulis V, Master VA, Cost NG, et al. International consultation on urologic diseases and the European association of urology on locally advanced renal cell carcinoma. Eur Urol. 2011;60:673–83. Interesting consensus panel on RCC with tumor thrombus.PubMedCrossRef
39.
Wellons E, Rosenthal D, Schoborg T, Shuler F, Levitt A. Renal cell carcinoma invading the inferior vena cava: use of a "temporary" vena cava filter to prevent tumor emboli during nephrectomy. Urology. 2004;63:380–2.PubMedCrossRef
40.
Kappa SF, Morgan TM, Keegan KA, Cookson MS. Inferior vena cava filter strut perforation discovered during right robotic-assisted laparoscopic partial nephrectomy. Urology. 2012;79:e49–50.PubMedCrossRef
41.
Chandra PA, Nwokolo C, Chuprun D, Chandra AB. Cardiac tamponade caused by fracture and migration of inferior vena cava filter. South Med J. 2008;101:1163–4.PubMedCrossRef
42.
Skinner E. Surgical approaches for open renal surgery. In: Smith JA, Howards SS, Preminger GM, editors. Hinman’s atlas of urologic surgery. 3rd ed. Philadelphia: Elsevier-Saunders; 2012. p. 799–832.
43.
Brown SR, Goodfellow PB. Transverse versus midline incisions for abdominal surgery. Cochrane Database Syst Rev. 2005;4:CD005199.PubMed
44.
Ciancio G, Vaidya A, Soloway M. Early ligation of the renal artery using the posterior approach: a basic surgical concept reinforced during resection of large hypervascular renal cell carcinoma with or without inferior vena cava thrombus. BJU Int. 2003;92:488–9.PubMedCrossRef
45.
Grantcharov TP, Rosenberg J. Vertical compared with transverse incisions in abdominal surgery. Eur J Surg. 2001;167:260–7.PubMedCrossRef
46.
Ciancio G, Gonzalez J, Shirodkar SP, Angulo JC, Soloway MS. Liver transplantation techniques for the surgical management of renal cell carcinoma with tumor thrombus in the inferior vena cava: step-by-step description. Eur Urol. 2011;59:401–6.PubMedCrossRef
47.
González J, Angulo J, Ciancio G. Surgical management of renal cell cancer with tumor thrombus through an exclusive transabdominal approach. Arch Esp Urol. 2011;64:297–309.PubMed
48.
González J, Shirodkar SP, Ciancio G. Multivisceral organ procurement for transplantation derived mobilization manoeuvres: very helpful auxiliary techniques in the excision of large retroperitoneal masses. Arch Esp Urol. 2011;64:257–66.PubMed
49.
Gorin MA, Garcia-Roig M, Shirodkar SP, Gonzalez J, Ciancio G. Modified surgical technique for the management of renal cell carcinoma with level I or II tumor thrombus. Urology. 2012;79:478–81.PubMedCrossRef
50.
Ciancio G, Vaidya A, Shirodkar S, Manoharan M, Hakky T, Soloway M. En bloc mobilization of the pancreas and spleen to facilitate resection of large tumors, primarily renal and adrenal, in the left upper quadrant of the abdomen: techniques derived from multivisceral transplantation. Eur Urol. 2009;55:1106–11.PubMedCrossRef
51.
Langenbuch C. Chirurgie der leben und gallenblase. Stuttgart: F. Enke Verlag; 1894.
52.
53.
Wotkowicz C, Libertino JA, Sorcini A, Mourtzinos A. Management of renal cell carcinoma with vena cava and atrial thrombus: minimal access vs median sternotomy with circulatory arrest. BJU Int. 2006;98:289–97.PubMedCrossRef
54.
Boorjian SA, Blute ML. Surgery for vena caval tumor extension in renal cancer. Curr Opin Urol. 2009;19:473–7.PubMedCrossRef
55.
González J. Update in the surgical management of renal cell carcinoma with venous extension. Curr Urol Rep. 2012;13:8–15.PubMedCrossRef
56.
Novick AC, Kaye MC, Cosgrove DM, et al. Experience with cardiopulmonary bypass and deep hypothermic circulatory arrest in the management of retroperitoneal tumors with large vena caval thrombi. Ann Surg. 1990;212:472–6.PubMedCrossRefPubMedCentral
57.
Marshall FF, Reitz BA, Diamond DA. A new technique for management of renal cell carcinoma involving the right atrium. Hypothermia and cardiac arrest. J Urol. 1984;131:103–7.PubMed
58.
Vaislic C, Puel P, Grondin P, et al. Cancer of the kidney invading the vena cava and heart. Results after 11 years of treatment. J Thorac Cardiovasc Surg. 1986;91:604–9.PubMed
59.
Murphy GJ, Angelini GD. Side effects of cardiopulmonary bypass: what is the reality? J Card Surg. 2004;19:481–843.PubMedCrossRef
60.
Shirodkar SP, Ciancio G. Cardiopulmonary bypass and renal cell carcinoma with level IV tumour thrombus: can deep hypothermic circulatory arrest limit perioperative mortality? BJU Int. 2010;106:879.PubMedCrossRef
61.
Granberg CF, Boorgian SA, Schaff HV, et al. Surgical management, complications and outcome of radical nephrectomy with inferior vena cava tumor thrombectomy facilitated by vascular by-pass. Urology. 2008;72:148–52.PubMedCrossRef
62.
Chowdhry UK, Mishra AK, Seth A, et al. Novel techniques for tumor thrombectomy for renal cell carcinoma with intraatrial tumor thrombus. Ann Thorac Surg. 2007;83:1731–6.CrossRef
63.
Bertini R, Roscigno M, Lapenna E, et al. Radical nephrocapsulectomy and caval thrombectomy with extracorporeal circulation and deep hypothermic circulatory arrest in right anterior minithoracotomy: a minimally invasive approach. Urology. 2008;71:957–61.PubMedCrossRef
64.
Mazzola A, Gregorini R, Villani C, et al. Cavoatrial tumor thrombectomy with systemic circulatory arrest and antegrade cerebral perfusion. Ann Thorac Surg. 2007;83:1564–5.PubMedCrossRef
65.••
Gonzalez J, Gorin MA, Garcia-Roig M, Ciancio G. Inferior vena cava resection and reconstruction: technical considerations in the surgical management of renal cell carcinoma with tumor thrombus. Urol Oncol. 2014;32:34.e. 19-26. Interesting review on adjunct procedures to deal with RCC involving the IVC and the physiopathologic effects of IVC obstruction.CrossRef
Metadata
Title
Caval Thrombus in Conjunction with Renal Tumors: Indication for Surgery and Technical Details
Authors
J. González
G. Ciancio
Publication date
01-11-2014
Publisher
Springer US
Published in
Current Urology Reports / Issue 11/2014
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-014-0451-0

Other articles of this Issue 11/2014

Current Urology Reports 11/2014 Go to the issue

Invited Commentary

Current Controversies Regarding Oncologic Risk Associated with Polypropylene Midurethral Slings

Lower Urinary Tract Symptoms & Voiding Dysfunction (H Goldman and G Badlani, Section Editors)

Urinary Retention in Elderly Women: Diagnosis & Management

Urosurgery (A Stenzl, Section Editor)

Optimal Treatment of Non-Muscle Invasive Urothelial Carcinoma Including Perioperative Management Revisited

Urosurgery (A Stenzl, Section Editor)

Surgical Removal of Retroperitoneal Tumors After Chemotherapy Treated Testicular Tumors

Urosurgery (A Stenzl, Section Editor)

The Role of Extensive Lymphadenectomy in Upper Tract Malignant Disease

Urosurgery (A Stenzl, Section Editor)

Role of Radical Prostatectomy in Clinically Non-Organ-Confined Prostate Cancer