title: Precise control of caval and hepatic vessels: Surgical technique to treat level III caval thrombus concomitant to renal cell carcinoma.
abstract: BACKGROUND
  We investigated the surgical techniques, safety, and prevention of complications of nephrectomy and removal of tumour thrombus for treating level III inferior vena cava (IVC) concomitant to renal cell carcinoma (RCC). We did this by precise controlling IVC and hepatic vessels without a vascular bypass.
  
  
  METHODS
  In this series, we included 5 patients with level III IVC tumour thrombus below the hepatic vein concomitant to RCC. After precisely controlling the IVC and hepatic vessels, we then removed the thrombus en bloc with the renal vein. Blood loss volume, IVC clamping time, hypotension time, resuscitation, cardiocerebrovascular complications, and postoperative organ dysfunction were observed.
  
  
  RESULTS
  Surgery was successfully performed without perioperative death. Blood loss volume was 900 to 1500 mL, operation time was 165 to 250 minutes, vascular clamping time was 8 to 12 minutes, and intraoperative hypotension time was 9 to 12 minutes. Serious perioperative complications were not observed. Local recurrence was not observed during the 9 to 24 months of follow-up. One patient exhibited disease-free survival, 3 developed lung or liver metastasis, and 1 died 11 months after surgery.
  
  
  CONCLUSIONS
  Precise control of IVC and hepatic pedicle vessels, without vascular bypass, is a safe and effective surgical treatment for level III tumor thrombus below the hepatic vein concomitant to RCC. The procedure was conducted without increased risks of intraoperative hypotensive shock, difficult resuscitation, pulmonary embolism, and multiple organ dysfunctions.
authors.affiliation: Department of Urology, Affiliated Zhongda Hospital of Southeast University and Urologic Institute of Southeast University, NanJing, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Urology, Affiliated Zhongda Hospital of Southeast University and Urologic Institute of Southeast University, NanJing, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Xu
authors.affiliation: Department of Urology, Affiliated Zhongda Hospital of Southeast University and Urologic Institute of Southeast University, NanJing, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Liu
authors.affiliation: Department of Urology, Affiliated Zhongda Hospital of Southeast University and Urologic Institute of Southeast University, NanJing, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Department of Urology, Affiliated Zhongda Hospital of Southeast University and Urologic Institute of Southeast University, NanJing, China.
authors.forename: Yiduo
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Urology, Affiliated Zhongda Hospital of Southeast University and Urologic Institute of Southeast University, NanJing, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Urology, Affiliated Zhongda Hospital of Southeast University and Urologic Institute of Southeast University, NanJing, China.
authors.forename: Xiaowen
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Urology, Affiliated Zhongda Hospital of Southeast University and Urologic Institute of Southeast University, NanJing, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Sun
authors.affiliation: Department of Urology, Affiliated Zhongda Hospital of Southeast University and Urologic Institute of Southeast University, NanJing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Urology, Affiliated Zhongda Hospital of Southeast University and Urologic Institute of Southeast University, NanJing, China.
authors.forename: Weidong
authors.initials: W
authors.lastname: Zhu
authors.affiliation: Department of Urology, Affiliated Zhongda Hospital of Southeast University and Urologic Institute of Southeast University, NanJing, China.
authors.forename: Shuqiu
authors.initials: S
authors.lastname: Chen