title: Incidence, histology and management of intraluminal thrombus at post-chemotherapy retroperitoneal lymph node dissection.
abstract: OBJECTIVE
  We determined the incidence, histology and management of intraluminal thrombus in a large group of patients treated with post-chemotherapy retroperitoneal lymph node dissection.
  
  
  METHODS
  We queried the testicular cancer database at our institution from January 1990 to June 2010. Tumor resection en bloc with major vascular structures and/or thrombectomy at post-chemotherapy retroperitoneal lymph node dissection was done in 240 patients, of whom 89 had a total of 98 intraluminal thrombi involving major vasculature.
  
  
  RESULTS
  The site of the 98 thrombi was the inferior vena cava (72), aorta (1) and renal vein (20). Management of the 72 vena caval thrombi included cavectomy (36), partial cavectomy (9) and thrombectomy (27). For the 20 renal vein thrombi management included nephrectomy (18) and thrombectomy (2). The single aortic thrombus was managed by aortic resection and replacement. Pathological evaluation revealed bland thrombi in 31 cases, necrosis in 23, teratoma in 28, active germ cell cancer in 12 and sarcoma in 4. In 40 patients a total of 71 additional procedures were required, including nephrectomy in 32, liver resection in 6, bowel resection in 7, thoracotomy in 6, vertebral resection in 3, orchiectomy in 11, and duodenal repair, ureteroureterotomy, stent removal, cholecystectomy, appendectomy and paraspinal tumor removal in 1 each. There were 17 Clavien III or worse complications in a total of 11 patients, including 2 deaths. Average estimated blood loss was 1,165 ml (range 200 to 7,000) and average hospital stay was 9.3 days (range 2 to 70).
  
  
  CONCLUSIONS
  The incidence of intraluminal thrombus at post-chemotherapy retroperitoneal lymph node dissection is 5.8%. Cancer pathology was observed in 44.9% of cases. Surgeons who perform post-chemotherapy retroperitoneal lymph node dissection should be well versed in vascular techniques with respect to the major vasculature.
authors.affiliation: Department of Urology, Indiana University Medical Center, Indianapolis, Indiana 46202, USA. phjohnston@hotmail.com
authors.forename: Paul
authors.initials: P
authors.lastname: Johnston
authors.forename: Stephen D W
authors.initials: SD
authors.lastname: Beck
authors.forename: Liang
authors.initials: L
authors.lastname: Cheng
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Masterson
authors.forename: Richard
authors.initials: R
authors.lastname: Bihrle
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kesler
authors.forename: Richard S
authors.initials: RS
authors.lastname: Foster
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D016208:Databases, Factual; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D012187:Retroperitoneal Space / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D017131:Thrombectomy / Q000379:methods; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D055815:Young Adult
keywords: IVC; PC; RPLND; blood supply; inferior vena cava; lymph node excision; post-chemotherapy; retroperitoneal lymph node dissection; testicular neoplasms; testis; thrombosis