title: Long-term physiologic and oncologic outcomes of inferior vena cava thrombosis in pediatric malignant abdominal tumors.
abstract: BACKGROUND
  The long-term physiologic and oncologic outcomes of treatment for inferior vena cava (IVC) thrombosis in children with malignant abdominal tumors are unclear.
  
  
  METHODS
  We conducted a retrospective review of children with malignant IVC tumor thrombosis treated at our institution between January 1996 and December 2011. Extent of tumor thrombus was classified using the Hinman system. Disease stage, management, and oncologic and physiologic outcomes and complications were evaluated.
  
  
  RESULTS
  We identified 15 patients (median age, 4.7 years): 12 with Wilms tumor, 2 with hepatoblastoma, and 1 with adrenocortical carcinoma. Neoadjuvant chemotherapy changed Hinman levels in 2 (13%) patients. IVC thrombus resection was complete in 6 (40%) patients, partial in 7 (47%) patients, and not performed in 1 (6.7%) patient. On follow-up imaging, 8 (53%) patients' IVCs were patent, 6 (40%) had residual thrombus, and 1 (6.7%) was surgically interrupted. Three (20%) patients had perioperative complications, and 2 (13%) experienced transient effects related to IVC occlusion.
  
  
  CONCLUSIONS
  Surgical management of tumor thrombus in the vena cava of children with solid abdominal tumors is challenging. Evidence on which to base strong treatment recommendations is lacking. Few long-term physiologic complications were observed.
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, United States; Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore.
authors.forename: Amos
authors.initials: A
authors.lastname: Loh
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Bishop
authors.affiliation: Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, United States.
authors.forename: Matthew
authors.initials: M
authors.lastname: Krasin
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, United States; Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN 38103, United States.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Davidoff
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, United States; Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN 38103, United States; Division of Pediatric Surgery, Le Bonheur Children's Hospital, Memphis, TN 38103, United States. Electronic address: mlangham@uthsc.edu.
authors.forename: Max R
authors.initials: MR
authors.lastname: Langham
mesh_terms: D000008:Abdominal Neoplasms / Q000150:complications*; D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000150:complications; D018268:Adrenocortical Carcinoma / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018197:Hepatoblastoma / Q000150:complications; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications; D008297:Male; D012189:Retrospective Studies; D017131:Thrombectomy; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery*; D020246:Venous Thrombosis / Q000209:etiology / Q000601:surgery*; D009396:Wilms Tumor / Q000150:complications
keywords: Inferior vena cava; Pediatric solid tumor; Tumor thrombus; Venous thrombectomy; Venous thrombosis