Renal Cell Carcinoma with Level IV Cavo-Atrial Thrombus: Short Term and Long Term Outcomes

Rajendra B Nerli

Department of Urology, KLES Dr Prabhakar Kore Hospital & MRC, Belgaum, Karnataka, India

^*Correspondance to: Rajendra B Nerli 

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Abstract:

Introduction: With the technological advances surgical treatment of Renal Cell Carcinoma with a level IV Cavo-Atrial Thrombus is now feasible, and the thrombus can almost always be removed successfully. Patients with level IV Inferior Vena Caval thrombus can be treated safely and effectively via radical nephrectomy and thrombectomy using Cardiopulmonary Bypass combined with Deep Hypothermic Circulatory arrest.Materials and
Methods: During the study period, 20 patients (16 male and 4 female) underwent surgery for RCC with IVC tumor thrombus extending into the right atrium. Preoperative workup included chest, abdomen and pelvis CT scan, and Magnetic Resonance Imaging (MRI). Following surgery all of the patients were followed up with a complete blood serum chemistry panel, chest X-ray and abdominal CT.Results: A total of 20 patients with mean (SD) age of 49.65 ± 10.32 years underwent radical nephrectomy with IVC thrombectomy. Preoperatively all these patients were diagnosed to have a T3cN0M0 RCC on clinical and radiological imaging. The mean (SD) operating time was 247.25 ± 40.08 mins, and the mean (SD) hypothermic circulatory arrest time was 17.25 ± 1.48 mins at a mean core temperature of 20.4 ± 2.8°C. In a mean follow of 40.85 months, malignancy was the cause of death in 9 of these patients, whereas five other patients died of causes unrelated to RCC and six patients are still alive postoperatively. The median survival after the operation was 31.5 months.Conclusion: Patients with level IV IVC thrombus RCC can be treated safely and effectively via radical nephrectomy and thrombectomy using CPB combined with DHCA. This approach is associated with low rates of morbidity and mortality.

Keywords:

Cardiopulmonary bypass; Hypothermic arrest; Renal cell carcinoma; Thrombectomy; Tumor thrombus

Cite the Article:

Nerli RB. Renal Cell Carcinoma with Level IV Cavo-Atrial Thrombus: Short Term and Long Term Outcomes. Clin Oncol. 2017; 2: 1219.