Multidisciplinary Treatment For Renal Cell Carcinoma Involving Inferior Vena Cava

Objective To evaluate surgical treatment for renal cell carcinoma with inferior vena cava tumor thrombus and the clinical significance of multidisciplinary treatment.Methods Two cases of renal cell carcinoma with inferior vena cava thrombus diagnosed by Doppler ultrasonography and CT were included in this retrospective analysis. Tumor thrombus was in level II in one case and in level IV in the other, and data were analyzed in terms of surgical indication, operation time, operative blood loss and postoperative hospital stay. Coagulation test and complete blood count were done again before surgery. Human Albumin, fibrinogen, prothrombin complex, plasma, platelet, UW and irrigating solution were prepared before the operation. Under general anesthesia, surgery was performed using abdomen inverted Y shaped incision.Right radical nephrectomy was finished by urological surgeon;vena cava was completely dissected from the renal vein level to the secondary porta of liver by hepatobiliary surgeon, vena cava and the surrounding branch vein were blocked in the upper and lower vena cava tumor thrombus;the tumor thrombus was removed completely by vascular surgeon.In the case(patient with level IV thrombus) where the tumour thrombus invaded the wall of the vena cava, the thrombus was found to be extending to the cavo-atrial junction but not into the right atrium. Left femoral venous-right atrial bypass was established, cardiopulmonary bypass last for241min, and the aorta was blocked for18min. Salvage autotransfusion was used during surgery,and the hepatic vein of secondary liver porta was anastomosed to artificial vascular graft.Results Right radical nephrectomy and inferior vena cava thrombectomy were performed successfully, and the2patients were discharged on the15th and27th day after surgery, respectively. The2patients had been followed up for1and16months after surgery, respectively,and both of them survived without local recurrence and distant metastasis.Conclusions Radical nephrectomy and inferior vena cava thrombectomy is the preferred method for patients without metastasis, and the multidisciplinary cooperation could shorten the operation time, reduce tumor recurrence and increase the survival rate of the patients.