Results of endoluminal occlusion of the inferior vena cava during radical nephrectomy and thrombectomy.
BACKGROUND
The surgical management of renal tumours with thrombi in the inferior vena cava (IVC) has become the gold standard treatment.


OBJECTIVE
To evaluate endoluminal occlusion of the IVC during radical nephrectomy with either retrohepatic (level II) or suprahepatic (level III) caval tumour thrombus.


METHODS
From January 2000 to October 2007, 28 consecutive patients with renal cell carcinoma presenting a thrombus level II or III were treated with endoluminal occlusion of the free IVC cranial.


METHODS
The occlusion balloon was positioned under transesophageal echography (TEE) control through a cavotomy performed at the level of the renal vein ostium. Thrombectomy and radical nephrectomy were then performed.


METHODS
Operative time, perioperative bleeding, and pre- and postoperative complications were assessed. Overall patient survival time, disease-free survival, and development of metastasis were assessed.


CONCLUSIONS
Caval thrombectomy was performed successfully in all patients. IVC replacement with an expanded polytetrafluoroethylene graft or patch closure after lateral cavectomy was performed in 10 and 4 patients, respectively. Average operative time was 160 min (range: 120-210). There was no perioperative mortality. The complications were one splenectomy and one early thrombosis of the IVC. Mean length of follow-up was 22.1 mo (range: 3-90). There was no local or IVC tumour recurrence. Cause-specific death and metastasis occurred in six (21.4%) and nine patients (32.1%), respectively. Thirteen patients (46.4%) are disease-free.


CONCLUSIONS
Endoluminal occlusion of the IVC with TEE monitoring for level II and III thrombus avoided a suprahepatic or subdiaphragmatic approach of the IVC. Segmental resection and reconstruction of the IVC could also be performed in case of adherent thrombi.
Department of Urology, Lille Regional University Teaching Hospital, Lille, France. laurent.zini@gmail.com
Laurent
L
Zini
Mohamed
M
Koussa
Stephan
S
Haulon
Christophe
C
Decoene
Jean-Christophe
JC
Fantoni
Jacques
J
Biserte
Arnauld
A
Villers
D000328:Adult; D000368:Aged; D021721:Balloon Occlusion; D002292:Carcinoma, Renal Cell / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D009392:Nephrectomy; D017131:Thrombectomy / Q000379:methods*; D014682:Vena Cava, Inferior; D055815:Young Adult