Mukul B Patil1, Jeremy Montez1, Jeffrey Loh-Doyle1, Jie Cai1, Eila C Skinner1, Anne Schuckman1, Duraiyah Thangathurai1, Donald G Skinner1, Siamak Daneshmand2. 1. Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California. 2. Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California. Electronic address: siadaneshmand@yahoo.com.
Abstract
PURPOSE: Inferior vena cava tumor thrombectomy requires experienced surgical teams due to complex hemodynamic considerations. The teams often use vascular bypass techniques that introduce additional risk. Inferior vena caval control in the pericardium obviates the need for cardiopulmonary bypass. We reviewed our experience with intrapericardial control during inferior vena caval tumor thrombectomy to evaluate perioperative outcomes and determine factors associated with overall survival. MATERIALS AND METHODS: We retrospectively reviewed the records of 87 patients who underwent nephrectomy with inferior vena caval tumor thrombectomy using intrapericardial inferior vena caval control from 1978 to 2012. This technique was performed in all 43 and 35 cases of intrahepatic and supradiaphragmatic thrombi, respectively, and in 9 select cases of intra-atrial thrombi. Patient demographics, operative variables and postoperative outcomes were examined. Multivariate regression analysis was used to determine associations between clinical variables and overall survival. RESULTS: Mortality 30 days perioperatively was 9.2% and the incidence of high grade complications was 19.5%. Median survival was 3.1 and 2.5 years in patients with pT3bN0 and pT3cN0, respectively. Extended regional lymphadenectomy, which was performed in all cases, revealed nodal metastasis in 38%. On multivariate analysis ECOG greater than 2 and pT3c stage were associated with worse survival. Histological grade, perinephric fat invasion and lymph node involvement were not associated with worse survival. CONCLUSIONS: Intrapericardial control of the inferior vena cava enables a single surgical team to safely perform tumor thrombectomy for intrahepatic and supradiaphragmatic thrombi, eliminating the risk and morbidity related to cardiopulmonary bypass. Although supradiaphragmatic extent and ECOG greater than 2 are associated with worse survival, complete resection with lymphadenectomy can allow for long-term survival in patients with locally advanced disease.
PURPOSE: Inferior vena cava tumor thrombectomy requires experienced surgical teams due to complex hemodynamic considerations. The teams often use vascular bypass techniques that introduce additional risk. Inferior vena caval control in the pericardium obviates the need for cardiopulmonary bypass. We reviewed our experience with intrapericardial control during inferior vena caval tumor thrombectomy to evaluate perioperative outcomes and determine factors associated with overall survival. MATERIALS AND METHODS: We retrospectively reviewed the records of 87 patients who underwent nephrectomy with inferior vena caval tumor thrombectomy using intrapericardial inferior vena caval control from 1978 to 2012. This technique was performed in all 43 and 35 cases of intrahepatic and supradiaphragmatic thrombi, respectively, and in 9 select cases of intra-atrial thrombi. Patient demographics, operative variables and postoperative outcomes were examined. Multivariate regression analysis was used to determine associations between clinical variables and overall survival. RESULTS: Mortality 30 days perioperatively was 9.2% and the incidence of high grade complications was 19.5%. Median survival was 3.1 and 2.5 years in patients with pT3bN0 and pT3cN0, respectively. Extended regional lymphadenectomy, which was performed in all cases, revealed nodal metastasis in 38%. On multivariate analysis ECOG greater than 2 and pT3c stage were associated with worse survival. Histological grade, perinephric fat invasion and lymph node involvement were not associated with worse survival. CONCLUSIONS: Intrapericardial control of the inferior vena cava enables a single surgical team to safely perform tumor thrombectomy for intrahepatic and supradiaphragmatic thrombi, eliminating the risk and morbidity related to cardiopulmonary bypass. Although supradiaphragmatic extent and ECOG greater than 2 are associated with worse survival, complete resection with lymphadenectomy can allow for long-term survival in patients with locally advanced disease.
Authors: Hao G Nguyen; Derya Tilki; Marc A Dall'Era; Blythe Durbin-Johnson; Joaquín A Carballido; Thenappan Chandrasekar; Thomas Chromecki; Gaetano Ciancio; Siamak Daneshmand; Paolo Gontero; Javier Gonzalez; Axel Haferkamp; Markus Hohenfellner; William C Huang; Estefania Linares Espinós; Philipp Mandel; Juan I Martinez-Salamanca; Viraj A Master; James M McKiernan; Francesco Montorsi; Giacomo Novara; Sascha Pahernik; Juan Palou; Raj S Pruthi; Oscar Rodriguez-Faba; Paul Russo; Douglas S Scherr; Shahrokh F Shariat; Martin Spahn; Carlo Terrone; Daniel Vergho; Eric M Wallen; Evanguelos Xylinas; Richard Zigeuner; John A Libertino; Christopher P Evans Journal: J Urol Date: 2015-03-19 Impact factor: 7.450
Authors: D V Shchukin; V N Lesovoy; G G Khareba; A I Harahatyi; A V Maltsev; M M Polyakov; R V Stetsyshyn; M P Kopytsya; P V Mozzhakov; O O Makovozov Journal: Adv Urol Date: 2020-06-18
Authors: Robert Sobczyński; Tomasz Golabek; Mikolaj Przydacz; Tomasz Wiatr; Jakub Bukowczan; Jerzy Sadowski; Piotr Chłosta Journal: Cent European J Urol Date: 2015-08-21