Objective
To describe the feasibility and perioperative outcome of suprarenal resection of inferior
vena cava (IVC) in urologic neoplasms without reconstruction.
Methods
We retrospectively reviewed the patients who underwent suprarenal resection of IVC
without reconstruction for urologic neoplasms in our institution between September
2010 and October 2019. Patients’ demographic, clinical, radiologic, and 90-day perioperative
complications were recorded.
Results
Twenty-eight (79% male) patients with a median age of 59 (25-75) years were included
in the study. Twenty-five (89%) of patients had renal cell carcinoma, 1 had renal
leiomyosarcoma, and 2 had metastatic testicular teratoma. Twenty-two patients had
Mayo level 3 thrombus, 3 had level 2, and 3 had level 4. The mean radiologic thrombus
length was 12.6 cm. Eleven patients had radiologic bland thrombosis in the infrarenal
IVC. Twenty-seven patients underwent open, and 1 robotic surgery. The median operating
time was 411 (range 240-808) minutes, median blood loss was 3750 cc, and all but 1
patient received perioperative transfusion (median 11 units of packed red blood cells).
Median hospital stay was 5 (3-50) days. Ninety-day complication rate was 35% (Clavien-Dindo
grade I/II and III/IV were 21% and 14%, respectively). Four patients (14%) developed
transient nondisabling leg edema. The 90-day mortality rate was 7%.
Conclusion
Suprarenal inferior vena cava resection without reconstruction is feasible, yet high-risk
operation that should be performed in experienced centers in selected patients with
urologic malignancies.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Resection of the inferior vena cava for neoplasms with or without prosthetic replacement: a 14-patient series.Ann Surg. 2001; 233: 242-249https://doi.org/10.1097/00000658-200102000-00014
- Resection of the inferior vena cava without reconstruction for urologic malignancies.Urology. 2009; 74: 1257-1262https://doi.org/10.1016/j.urology.2009.06.092
- Resection of malignant tumors invading the vena cava: perioperative complications and long-term follow-up.J Vasc Surg. 2007; 46: 533-540https://doi.org/10.1016/j.jvs.2007.04.067
- Replacement of the inferior vena cava for malignancy: an update.J Vasc Surg. 2000; 31: 270-281https://doi.org/10.1016/s0741-5214(00)90158-7
- Resection and reconstruction of the inferior vena cava for neoplasms.World J Gastrointest Surg. 2012; 4: 96-101https://doi.org/10.4240/wjgs.v4.i4.96
- Surgical treatment of renal cancer with vena cava extension.Br J Urol. 1987; 59: 390-395https://doi.org/10.1111/j.1464-410x.1987.tb04832.x
- Inferior vena cava resection and reconstruction: technical considerations in the surgical management of renal cell carcinoma with tumor thrombus.Urol Oncol. 2014; 32 (34.e19–26)https://doi.org/10.1016/j.urolonc.2013.01.004
- Venous resection in urological surgery.J Urol. 2008; 180: 2338-2342https://doi.org/10.1016/j.juro.2008.08.028
- Management of inferior vena cava tumor thrombus in locally advanced renal cell carcinoma.Ther Adv Urol. 2015; 7: 216-229https://doi.org/10.1177/1756287215576443
- Clinical and radiographic predictors of the need for inferior vena cava resection during nephrectomy for patients with renal cell carcinoma and caval tumour thrombus.BJU Int. 2015; 116: 388-396https://doi.org/10.1111/bju.13005
- Results of inferior vena caval interruption by greenfield filter, ligation, or resection during radical nephrectomy and tumor thrombectomy.J Urol. 2007; 178: 440-445https://doi.org/10.1016/j.juro.2007.03.121
- Clinical and radiographic predictors of great vessel resection or reconstruction during retroperitoneal lymph node dissection for testicular cancer.Urology. 2019; 123: 186-190
- Long-term results after inferior vena caval resection during retroperitoneal lymphadenectomy for metastatic germ cell cancer.J Vasc Surg. 1998; 28: 808-814https://doi.org/10.1016/s0741-5214(98)70055-2
- Vena caval resection for bulky metastatic germ cell tumors: an 18-year experience.J Urol. 1997; 158: 1813-1818https://doi.org/10.1016/s0022-5347(01)64137-5
- Resection of the suprarenal inferior vena cava for retroperitoneal malignant disease.J Urol. 1979; 121: 112-118https://doi.org/10.1016/s0022-5347(17)56684-7
- Resection of the suprarenal inferior vena cava. The role of prosthetic replacement.Arch Surg. 1995; 130: 793-797https://doi.org/10.1001/archsurg.1995.01430070115025
- Prosthetic replacement of the infrahepatic inferior vena cava for leiomyoscarcoma.Arch Surg. 2006; 141 (discussion 924): 919-924https://doi.org/10.1001/archsurg.141.9.919
- Vena cava replacement for malignant disease: is there a role?.Ann Vasc Surg. 1993; 7: 51-62https://doi.org/10.1007/BF02042660
- Replacement of the inferior vena cava for malignancy: an update.J Vasc Surg. 2000; 31: 270-281https://doi.org/10.1016/s0741-5214(00)90158-7
- Circumferential resection of the inferior vena cava for primary and recurrent malignant tumors.J Urol. 2009; 182: 887-893https://doi.org/10.1016/j.juro.2009.05.015
- Surgical technique, morbidity, and outcome of primary retroperitoneal sarcoma involving inferior vena cava.Ann Surg Oncol. 2012; 19: 511-518https://doi.org/10.1245/s10434-011-1954-2
- Inferior vena cava resection and reconstruction for retroperitoneal tumor excision.J Vasc Surg. 2012; 55: 1386-1393https://doi.org/10.1016/j.jvs.2011.11.054
- Surgical resection and inferior vena cava reconstruction for treatment of the malignant tumor: technical success and outcomes.Ann Vasc Dis. 2014; 7: 120-126https://doi.org/10.3400/avd.oa.13-00125
- European association of urology guidelines on renal cell carcinoma: the 2019 update.Eur Urol. 2019; 75: 799-810https://doi.org/10.1016/j.eururo.2019.02.011
- Neoadjuvant sunitinib decreases inferior vena caval thrombus size and is associated with improved oncologic outcomes: a multicenter comparative analysis.Clin Genitourin Cancer. 2019; 17: e505-e512https://doi.org/10.1016/j.clgc.2019.01.013
- Current status of immunotherapy for localized and locally advanced renal cell carcinoma.J Oncol. 2019; 20197309205https://doi.org/10.1155/2019/7309205
- Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma.N Engl J Med. 2018; 379: 417-427https://doi.org/10.1056/NEJMoa1803675
- Surgical management of advanced kidney cancer: the role of cytoreductive nephrectomy and lymphadenectomy.J Clin Oncol. 2018; 36: 3601-3607https://doi.org/10.1200/JCO.2018.79.0246
Article info
Publication history
Published online: April 24, 2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
