Vena Cavoscopy in the Assessment of Intraluminal Vena Caval Tumor Involvement: Beyond the Abstract

Tumor thrombus and invasion of the inferior vena cava from malignancy represents a challenge to the urologic oncologist. Many techniques and imaging modalities have been investigated to improve the identification and management of tumor thrombus and invasion involving the vena cava. This is particularly challenging when the thrombus is friable, extends caudally towards to the bifurcation, or involves the hepatic veins.
In this article, we present our experience in using a flexible cystoscope to perform a complete assessment of the cava after tumor thrombectomy. Over an 8-year period, 36 patients underwent tumor thrombecomy and subsequent vena cavoscopy. During that time, we have found that cavoscopy assists in identification of residual thrombus or caval invasion that would have been otherwise missed using traditional techniques. 8 patients in our study cohort were found to have residual tumor thrombus or caval invasion which provided the indication to either a.) perform cavectomy or b.) remove the residual thrombus.

The clinical implication of this work is to show that significant residual pathology in the cava can remain after initial thrombectomy. Based on the results of our study, we believe that vena cavoscopy can help surgeons overcome this problem by permitting complete and expeditious visualization of the vena cava.

Written by: Jeffrey Loh-Doyle, MD

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