Objective
To improve confirmation of complete tumor thrombus removal in advanced malignancy,
we report on our experience using intraoperative vena cavoscopy using a flexible cystoscope
to confirm complete thrombus resection. Patients with renal cell carcinoma or testicular
cancer associated with inferior vena caval tumor involvement benefit from surgical
resection of the primary tumor and the tumor thrombus. Intraoperative assessment of
the vena cava represents a technical challenge, particularly when the thrombus is
friable and involves the hepatic veins, or there is caudal extension of thrombus toward
the bifurcation.
Material and Methods
From 2006 to 2014, 36 patients underwent tumor thrombectomy and vena cavoscopy. When
residual caval thrombus was suspected, a flexible cystoscope was inserted into the
vena cava for direct visual inspection of the caval lumen. Perioperative outcomes
including residual tumor, changes in management, and postoperative complications were
analyzed.
Results
All patients underwent endoscopy of the caval lumen without complications. Eight of
36 (22%) patients were found to have residual tumor thrombus visualized during cavoscopy.
Five of these patients had evidence of residual mass and caval invasion within the
caval lumen that ultimately resulted in cavectomy. Two patients had residual tumor
thrombus that was bluntly removed. One patient was found to have significant involvement
of the hepatic veins.
Conclusion
Vena cavoscopy using a flexible cystoscope is a practical technique that may be utilized
intraoperatively to ensure clearance of residual thrombus burden within the inferior
vena cava and to assess for caval invasion.
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Article info
Publication history
Published online: November 27, 2017
Accepted:
November 15,
2017
Received:
September 28,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
