Circumferential Inferior Vena Cavectomy Without Caval Replacement in the Management of Renal Cell Carcinoma with Tumor Thrombus.

Autor: Gonzalez de Gor Herrera V; Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain., Asencio Pascual JM; Departamento de Cirugía, Facultad de Medicina, Universidad Complutense, C/ Dr Esquerdo, 46, 28007, Madrid, Spain. joseasen@ucm.es.; Servicio de Cirugía General y del Aparato Digestivo (Sección de Cirugía HBP), Hospital General Universitario Gregorio Marañón, Madrid, Spain. joseasen@ucm.es.; Hospital General Universitario Gregorio Marañón, Madrid, Spain. joseasen@ucm.es., González J; Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Hospital General Universitario Gregorio Marañón, Madrid, Spain., Herranz Amo F; Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Hospital General Universitario Gregorio Marañón, Madrid, Spain., LLedó García E; Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Hospital General Universitario Gregorio Marañón, Madrid, Spain., Sánchez Ochoa M A; Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain., Hernández Fernández C; Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Jazyk: angličtina
Zdroj: Current urology reports [Curr Urol Rep] 2024 Jun; Vol. 25 (6), pp. 117-124. Date of Electronic Publication: 2024 May 20.
DOI: 10.1007/s11934-024-01203-x
Abstrakt: Purpose of Review: Renal cell carcinoma presents a unique proclivity for vascular involvement giving rise to a peculiar form of locally advanced disease so-called tumor thrombus. To date, the only curative strategy for these cases remains surgery, which should aim to remove every vestige of macroscopic disease. Most of the preexisting literature advocates opening the vena cava to allow tumor thrombus removal and subsequent venous suture closure. However, inferior vena cava circumferential resection (cavectomy) without caval replacement is possible in the majority of cases since progressive occlusion facilitates the development of a collateral venous network aimed at maintaining cardiac preload.
Recent Findings: Radical nephrectomy with tumor thrombectomy remains a surgical challenge not exempt of operative complications even in experienced hands. In opposition to what traditional cavotomy and thrombus withdrawal can offer, circumferential cavectomy without caval replacement would provide comparable or even better oncologic control, decrease the likelihood of operative bleeding, and prevent the development of perioperative pulmonary embolism. This review focuses on the rationale of circumferential IVC resection without caval replacement and the important technical aspects of this approach in cases of renal cell carcinoma with vascular involvement. We also include an initial report on the surgical outcomes of a contemporary series of patients managed under this approach at our center.
(© 2024. The Author(s).)
Databáze: MEDLINE
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