Surgical treatment of nephrectomy and inferior vena cava thrombectomy in renal cell carcinoma with subdiaphragmatic thrombus
10.3760/cma.j.issn.1000-6702.2013.05.002
- VernacularTitle:肾癌伴膈下型癌栓的手术治疗
- Author:
Jianping ZHANG
;
Yu ZHU
;
Zongming LIN
;
Li ZHANG
;
Lian SUN
;
Jianming GUO
- Publication Type:Journal Article
- Keywords:
Carcinoma,renal cell;
Neoplasm circulating cells;
Nephrectomy;
Embolectomy
- From:
Chinese Journal of Urology
2013;(5):329-332
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the safety and efficacy of radical nephrectomy plus inferior vena cava thrombectomy,and to evaluate the efficacy of preoperative temporary inferior vena cava filter placement and intraoperative application of liver transplantation techniques to reveal the inferior vena cava in order to avoid tumor thrombosis shedding and embolism.Methods The data of 42 cases (January 2004 to December 2010) of renal cell carcinoma with subdiaphragmatic thrombus were analyzed retrospectively.All these patients underwent radical nephrectomy plus inferior vena cava thrombectomy.Patients were implanted temporary inferior vena cava filter as preoperative routine.Patients with the tumor thrombi behind the liver were applied liver transplant techniques to free and turn liver to the left in order to reveal inferior vena cava,block blood flow according to priority and then finish the inferior vena cava thrombectomy.The filter was removed postoperatively on the same day,and the patients were followed up as routine.Results The operation of the 42 cases was successful without symptomatic tumor thrombus embolism perioperatively,while 1 case died of severe postoperative lung infection.The average operation time was 220 min (130-320 min),blood loss was 750 ml (200-2500 ml),and 12 cases had blood transfusion with an average of 800 ml (400-2000 ml).Forty-one cases were followed up with an average period of 36 months (6-60 months).Among the 37 cases without preoperative tumor metastasis,15 cases had metastases and 22 cases had disease-free survival.Conclusions Nephrectomy and inferior vena cava thrombectomy could be safe and effective for renal cell carcinoma with subdiaphragmatic thrombosis.Preoperative temporary inferior vena cava filter placement and intraoperative application of liver transplantation techniques to reveal the inferior vena cava can be effective to prevent tumor thrombosis shedding and embolism and improve surgical safety.
