AIM: To retrospectively analyze patients treated by renal tumor and venous tumor thrombus (VVT) removal and to introduce a less stressful and safer surgical method without thoracotomy in Neves level 3 cases.
METHODS: From 2002 to 2011, 33 patients underwent surgery for renal cell cancer combined with tumor thrombus of the inferior vena cava. Preoperative symptoms, tumor-node-metastasis classification of tumors, thrombus extension classified by Neves and Zincke system, types of surgical interventions, complications, postoperative management, and survival results were analyzed.
RESULTS: Ten patients had level 1, 17 had level 2, and 6 had level 3 thrombi according to Neves and Zincke. In 5 patients with level 3 thrombi, the liver was mobilized without thoracotomy and in 1 patient endoluminal occlusion was utilized. There was no intraoperative mortality. The median survival time of 10 patients who died during follow-up period was 36.6 months (range, 0-121 months).
CONCLUSION: Renal cell cancer complicated with tumor thrombus without metastasis can be curable by performing a complete resection. The thrombus level determines the surgical approach and method. Our results confirm that level 3 caval vein tumor thrombus can be safely surgically treated by laparotomy with liver mobilization. Thoracotomy, use of cardiopulmonal bypass, and hypothermic circulatory arrest can be avoided with adequate liver- and vascular surgery methods.
Written by:
Nagy Z, Pánovics J, Szendrői A, Szász AM, Harsányi L, Romics I. Are you the author?
Zoltán Nagy, Division Head of General Surgery, Department of Surgery, Bajcsy-Zsilinszky Hospital, Building A, Floor I, Maglódi út 89-91, 1106 Budapest, Hungary.
Reference: Croat Med J. 2014 Jun 1;55(3):265-70.
doi: 10.3325/cmj.2014.55.265
PubMed Abstract
PMID: 24891285
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