|
|
 |
| |
2008 Annual Meeting Abstracts
A Single-Center Experience of Caval Thrombectomy in Patients with Renal Cell Carcinoma With Tumor Thrombus Extension into IVC
Benjamin M Brucker, Grace J. Wang*, Bruce Malkowicz, Benjamin Jackson*, Jeffrey P. Carpenter*, Ronald Fairman*, Edward Y. Woo*, Keith VanArsdalen
University of Pennsylvania, Philadelphia, PA
Introduction: To describe a single-center experience of caval thrombectomy in patients with renal cell carcinoma and tumor thrombus extension into the IVC.
Methods: We retrospectively reviewed 23 patients that underwent radical nephrectomy with caval thrombectomy. Follow-up included an office visit and CT scan. Statistical comparisons were made using two-sample t-tests.
Results: Mean patient age was 62 years (range 32-83). Mean tumor size was 8.6cm (range 3-21). Thrombus levels were as follows: I-2/23, II-6/23, III-13/26, IV-2/23. Tumor thrombi were removed via digital extraction (20), fogarty embolectomy (2), or endarterectomy (1). Lateral venorrhaphy was used for IVC repair in all cases. Hepatic mobilization and suprahepatic clamping were necessary in 14 patients. Clamp times were 15 and 9.4 minutes for suprahepatic (SH) and infrahepatic (IH) groups respectively (p<0.012). EBL was also significantly different (3.2L vs 2L, p<0.045). In the SH group two patients developed postoperative atrial fibrillation and two patients died. The IH group had no perioperative morbidity or mortality. 95% of patients (18/19) had a patent IVC at a median follow-up of 15 months. One SH patient developed an IVC stenosis 12 months postoperatively. There was 16% (3/19) recurrence rate, all demonstrating renal vascular invasion and high Fuhrman grade.
Conclusions: Caval thrombectomy can be performed safely during radical nephrectomy for RCC with tumor thrombus extension. The need for SH clamping is associated with longer clamp times, increased EBL, and increased morbidity and mortality. Lateral venorraphy with primary repair avoids complicated caval reconstructions and results in high patency rates with acceptable recurrence rate.
|
|
| |
|
|
| |
|
|
|
|
