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En Bloc Resection of Right Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus Without Caval Reconstruction: Is It Safe to Divide the Left Renal Vein?
INTRODUCTION: It has been suggested that inferior vena cava (IVC) reconstruction following resection of retroperitoneal tumors with IVC tumor thrombus (TT) is not required when adequate collateral circulation is present. There are no reports evaluating mid-term effects on renal function in these pat...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2022
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9280635/ https://www.ncbi.nlm.nih.gov/pubmed/35847837 http://dx.doi.org/10.3389/fonc.2022.877310 |
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author | Horodyski, Laura Gonzalez, Javier Tabbara, Marina M. Gaynor, Jeffrey J. Rodriguez-Cabero, Maria Herranz-Amo, Felipe Hernández, Carlos Shah, Rushi Ciancio, Gaetano |
author_facet | Horodyski, Laura Gonzalez, Javier Tabbara, Marina M. Gaynor, Jeffrey J. Rodriguez-Cabero, Maria Herranz-Amo, Felipe Hernández, Carlos Shah, Rushi Ciancio, Gaetano |
author_sort | Horodyski, Laura |
collection | PubMed |
description | INTRODUCTION: It has been suggested that inferior vena cava (IVC) reconstruction following resection of retroperitoneal tumors with IVC tumor thrombus (TT) is not required when adequate collateral circulation is present. There are no reports evaluating mid-term effects on renal function in these patients. The purpose of this study was to assess renal function after en bloc resection of right renal cell carcinoma (RCC) with obstructing IVC TT and the possible risks that may arise after left renal vein division. MATERIALS AND METHODS: A bi-institutional retrospective review was performed over a 15-year period, assessing patients with right RCC and obstructing level II–IV TT. All patients underwent extensive evaluation and cardiology clearance, and informed consent was obtained for right radical nephrectomy and thrombectomy with or without IVC reconstruction with possible cardiopulmonary bypass (CPB). Patient demographics, tumor characteristics, intraoperative factors, complications, length of stay, and patient survival were evaluated. Preoperative creatinine was recorded, as was creatinine on the day of discharge and at 6 and 12 months postoperatively. RESULTS: Twenty-two patients were included in the study. Median age at surgery was 62.5 (range: 45–79) years, and 19 (86%) of the patients were men. One patient (5%) had a level II thrombus, 14 patients (64%) had a level III thrombus (IIIa, n = 3; IIIb, n = 6; IIIc, n = 3; IIId, n = 2), and seven patients (32%) had a level IV thrombus. Intraoperatively, median estimated blood loss was 1.35 (range: 0.2–25) L. The median length of hospital stay was 11 (range: 5–50) days. Median preoperative creatinine was 1.20 (range: 0.40–2.70) mg/dl, and postoperatively, median creatinine was 1.3 (range: 0.86–2.20) mg/dl. Median creatinine levels at 6 months and 12 months postoperatively were 1.10 (range: 0.5–1.8) mg/dl and 1.40 (range: 0.6–2.0) mg/dl, respectively. Four patients died (range: 0.1–1.3 years), and median postoperative follow-up among the 18 ongoing survivors (at last follow-up) was 1.5 (range: 0.5–7.0) years. CONCLUSIONS: Resection of right RCC with an obstructing level II–IV TT without reconstruction of the IVC appears to not have a significant adverse effect on mid-term renal function after division of the left renal vein. |
format | Online Article Text |
id | pubmed-9280635 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-92806352022-07-15 En Bloc Resection of Right Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus Without Caval Reconstruction: Is It Safe to Divide the Left Renal Vein? Horodyski, Laura Gonzalez, Javier Tabbara, Marina M. Gaynor, Jeffrey J. Rodriguez-Cabero, Maria Herranz-Amo, Felipe Hernández, Carlos Shah, Rushi Ciancio, Gaetano Front Oncol Oncology INTRODUCTION: It has been suggested that inferior vena cava (IVC) reconstruction following resection of retroperitoneal tumors with IVC tumor thrombus (TT) is not required when adequate collateral circulation is present. There are no reports evaluating mid-term effects on renal function in these patients. The purpose of this study was to assess renal function after en bloc resection of right renal cell carcinoma (RCC) with obstructing IVC TT and the possible risks that may arise after left renal vein division. MATERIALS AND METHODS: A bi-institutional retrospective review was performed over a 15-year period, assessing patients with right RCC and obstructing level II–IV TT. All patients underwent extensive evaluation and cardiology clearance, and informed consent was obtained for right radical nephrectomy and thrombectomy with or without IVC reconstruction with possible cardiopulmonary bypass (CPB). Patient demographics, tumor characteristics, intraoperative factors, complications, length of stay, and patient survival were evaluated. Preoperative creatinine was recorded, as was creatinine on the day of discharge and at 6 and 12 months postoperatively. RESULTS: Twenty-two patients were included in the study. Median age at surgery was 62.5 (range: 45–79) years, and 19 (86%) of the patients were men. One patient (5%) had a level II thrombus, 14 patients (64%) had a level III thrombus (IIIa, n = 3; IIIb, n = 6; IIIc, n = 3; IIId, n = 2), and seven patients (32%) had a level IV thrombus. Intraoperatively, median estimated blood loss was 1.35 (range: 0.2–25) L. The median length of hospital stay was 11 (range: 5–50) days. Median preoperative creatinine was 1.20 (range: 0.40–2.70) mg/dl, and postoperatively, median creatinine was 1.3 (range: 0.86–2.20) mg/dl. Median creatinine levels at 6 months and 12 months postoperatively were 1.10 (range: 0.5–1.8) mg/dl and 1.40 (range: 0.6–2.0) mg/dl, respectively. Four patients died (range: 0.1–1.3 years), and median postoperative follow-up among the 18 ongoing survivors (at last follow-up) was 1.5 (range: 0.5–7.0) years. CONCLUSIONS: Resection of right RCC with an obstructing level II–IV TT without reconstruction of the IVC appears to not have a significant adverse effect on mid-term renal function after division of the left renal vein. Frontiers Media S.A. 2022-06-30 /pmc/articles/PMC9280635/ /pubmed/35847837 http://dx.doi.org/10.3389/fonc.2022.877310 Text en Copyright © 2022 Horodyski, Gonzalez, Tabbara, Gaynor, Rodriguez-Cabero, Herranz-Amo, Hernández, Shah and Ciancio https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Oncology Horodyski, Laura Gonzalez, Javier Tabbara, Marina M. Gaynor, Jeffrey J. Rodriguez-Cabero, Maria Herranz-Amo, Felipe Hernández, Carlos Shah, Rushi Ciancio, Gaetano En Bloc Resection of Right Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus Without Caval Reconstruction: Is It Safe to Divide the Left Renal Vein? |
title | En Bloc Resection of Right Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus Without Caval Reconstruction: Is It Safe to Divide the Left Renal Vein? |
title_full | En Bloc Resection of Right Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus Without Caval Reconstruction: Is It Safe to Divide the Left Renal Vein? |
title_fullStr | En Bloc Resection of Right Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus Without Caval Reconstruction: Is It Safe to Divide the Left Renal Vein? |
title_full_unstemmed | En Bloc Resection of Right Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus Without Caval Reconstruction: Is It Safe to Divide the Left Renal Vein? |
title_short | En Bloc Resection of Right Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus Without Caval Reconstruction: Is It Safe to Divide the Left Renal Vein? |
title_sort | en bloc resection of right renal cell carcinoma and inferior vena cava tumor thrombus without caval reconstruction: is it safe to divide the left renal vein? |
topic | Oncology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9280635/ https://www.ncbi.nlm.nih.gov/pubmed/35847837 http://dx.doi.org/10.3389/fonc.2022.877310 |
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