title: [Outcome of Resection of Inferior Vena Cava Superior to the Renal Vein in Renal Cell Carcinoma with Vena Caval Tumor Thrombus].
abstract: Surgical management with radical nephrectomy and thrombectomy has often been performed in renal cell carcinoma (RCC) with tumor thrombus infiltrating the inferior vena cava (IVC). We retrospectively reviewed the outcomes of IVC resection without venous reconstruction in patients with RCC and IVC thrombus at our institution. Eight patients with right RCC underwent radical nephrectomy and IVC resection superior to the level of the renal vein without venous reconstruction from August 2005 to February 2015. Thoracotomy, liver mobilization, and extracorporeal circulation were performed based on the IVC thrombus level. We assessed surgical outcomes, perioperative complications, and survival. At presentation, four patients had level IIIa IVC thrombus, three had level IIIb IVC thrombus, and one had level IV IVC thrombus. Perioperative imaging showed that three of the four patients who underwent neoadjuvant molecular targeting therapy achieved down-staging of the tumor thrombus level. The median operative time was 406 min, and the median estimated blood loss was 3,135 ml. With regard to IVC resectionassociated perioperative complications, one patient needed extracorporeal circulation with IVC ligation and Pringle maneuver owing to low blood pressure. Another patient underwent temporary hemodialysis for 8 days after surgery. There were no perioperative deaths, and none of the patients required permanent hemodialysis. Three patients survived the mean observation period of 25 months, including one patient with no recurrence. Three patients achieved long-term survival of more than 2 years. IVC resection without venous reconstruction may be a feasible option for patients with RCC and IVC tumor thrombus. Further study is needed to determine the most appropriate candidates for this procedure.
authors.affiliation: The Department of Urology, Akita University Graduate School of Medicine.
authors.forename: Soki
authors.initials: S
authors.lastname: Kashima
authors.affiliation: The Department of Urology, Akita University Graduate School of Medicine.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Narita
authors.affiliation: The Department of Urology, Akita University Graduate School of Medicine.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Saito
authors.affiliation: The Department of Urology, Akita University Graduate School of Medicine.
authors.forename: Makoto
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: The Department of Urology, Akita University Graduate School of Medicine.
authors.forename: Shinya
authors.initials: S
authors.lastname: Maita
authors.affiliation: The Department of Urology, Akita University Graduate School of Medicine.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tsuruta
authors.affiliation: The Department of Urology, Akita University Graduate School of Medicine.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Numakura
authors.affiliation: The Department of Urology, Akita University Graduate School of Medicine.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Maeno
authors.affiliation: The Department of Urology, Akita University Graduate School of Medicine.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Inoue
authors.affiliation: The Department of Urology, Akita University Graduate School of Medicine.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Tsuchiya
authors.affiliation: Center for Kidney Disease and Transplantation, Akita University Hospital.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Satoh
authors.affiliation: The Department of Cardiovascular Surgery, Akita University Graduate School of Medicine.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: The Department of Gastroenterological Surgery, Akita University Graduate School of Medicine.
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: The Department of Urology, Akita University Graduate School of Medicine.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Habuchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012189:Retrospective Studies; D017131:Thrombectomy; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*